Nursing care for schizophrenia. Rehabilitation of schizophrenia

Great value for successful treatment has a sister process to schizophrenia. Patients with this diagnosis require special care. It is provided by medical personnel medical institution, in which the patient is located. A difficult task is entrusted to him. Health care providers must cope with patients who do not recognize that they truly need treatment. This is the main difficulty of the work of a nurse.

The nurse should ensure that the patient takes all prescribed medications.

Nursing care for a patient diagnosed with schizophrenia is based on a set of important principles. Every nurse who will be caring for a person with a mental disorder should be familiar with them.

Important! Medical personnel who are familiar with the specifics of working with patients with this diagnosis are allowed to care for a schizophrenic.

First of all, the nurse who will look after the patient needs to study his data. She must know the patient's last name, first name and patronymic, his diagnosis and room number. She needs to try to gain the trust of the schizophrenic. To do this, you will need to find a special approach to the patient. Only a professional can achieve such a result.

The success of performing work duties and providing care to a patient with schizophrenia depends on whether the nurse fulfills the following requirements:

• When visiting the ward, medical staff must remove any jewelry from themselves, as patients may unknowingly try to rip them off;
• It is necessary to pay attention to the appearance of new symptoms that indicate a deterioration in the person’s condition. These cases should be reported to your doctor immediately;
• It is prohibited to have personal conversations with colleagues in the presence of patients. It is also unacceptable to discuss other patients in front of them, even if they do not know each other;
• The nurse should protect the patient from visitors if he is in the acute phase of a mental disorder. If relatives or friends ask to give notes to a person, then she is obliged to personally familiarize herself with them;
• Medical staff must inspect all transfers to the patient. If prohibited products or items are found, they are immediately returned to the sender;
• Constant monitoring of patients with schizophrenia is required. Compliance with this rule helps minimize the likelihood of patients being injured or committing suicide.

The nurse's responsibilities include monitoring the patient's actions during procedures. She must ensure that the patient takes his medications on time. She should also check the correct use of a thermometer and other items that are used to assess the current state of a person’s health.

Nursing process

Nursing care for patients with schizophrenia includes a number of tasks that must be performed by medical staff. The patient’s well-being and increased chances of achieving remission depend on the correctness and quality of these operations.

Correct nurse behavior

Only truly dedicated people should work with schizophrenics

The nurse is required to observe the behavior of her patient. She should become familiar with his emotional-volitional sphere, intellectual abilities and level of attention. She is also entrusted with the task of introducing the person to other patients who will be his neighbors in the ward.

The nurse should establish close contact with the patient. This will allow her to better assess his health and immediately learn about symptoms that were not previously identified by the doctor.

A person with schizophrenia has difficulty navigating places where he has never been before. Complicating the situation is short-term memory loss, which is not so rare in patients with this diagnosis. Therefore, the nurse needs to introduce the person in detail to the department and the ward in which his bed is located. It is possible that this action will have to be repeated several times. In about 2-3 weeks, schizophrenics finally remember their place and stop getting lost in the department if they accidentally leave the ward.

The behavior of a nurse when caring for a schizophrenic must meet the following requirements:

1. It is necessary to address the patient by his first name and patronymic and only as “you”. When speaking, you should be friendly in order to quickly gain the patient’s trust.
2. You cannot discuss his diagnosis with a person. The same applies to the doctor’s decisions regarding the treatment of the patient and conversations about the personal lives of other patients.
3. Before performing any procedure, you need to explain to the patient its meaning and significance for health. A casual conversation will allow him to relax and avoid unnecessary stress.
4. When communicating with close relatives of a schizophrenic, you should remain calm and friendly. The nurse has the right to tell them only the information that the attending physician has authorized.
5. It is the responsibility of the medical staff to explain to the patient’s relatives the principles of caring for him at home.

A good nurse performs her professional duties efficiently, even regardless of how she treats her patient. Relatives of the patient may offer various gifts and monetary rewards for their care. Medical staff are obliged to refuse this. Such “thanks” are unacceptable.

Comfortable environment in the rooms

Nurses are responsible for ensuring a comfortable environment in the wards of a patient with schizophrenia. Ideally, they should accommodate no more than two people. By following this rule, it is possible to provide each patient with sufficient free space.

Medical staff must ensure the cleanliness of the wards. They are responsible for timely cleaning and ventilation of these premises. They are also tasked with monitoring the provision of clean bed linen to patients.

Sleep and diet

Maintaining a clear and balanced schedule for people with mental disabilities is extremely important

By learning all the ins and outs of caring for people with schizophrenia, nurses will be prepared to provide comprehensive health care to their patients. Their responsibilities include monitoring the sleep, nutrition and physical activity patterns of schizophrenics.

The regime of rest, sleep and nutrition allows you to develop a number of conditioned reflexes that benefit patients. Thanks to the correct organization of time, the problem of sudden overwork of a person or the influence of factors on him that can provoke an exacerbation of a mental disorder is solved.

Nurses should carefully prepare the patient for sleep. They should ventilate the room and ensure that the patient takes care of personal hygiene. A certain time is allocated for these procedures, which is indicated in the daily routine.

If the patient is worried about anxiety or another painful condition, the nurse should reassure him. As prescribed by the doctor, he may be prescribed a sedative or sleeping pill.

Patients being treated for schizophrenia also eat according to the regimen. If the patient has no desire to eat, the nurse should try to persuade him to do so.

Symptoms that require drug therapy

Patients cannot cope without medications if they have an acute course of schizophrenia.

The medical staff performs the function of monitoring that the patient takes the medications prescribed by the doctor at the prescribed time and in the correct dosage.

Avoid carrying out drug therapy will not succeed if the patient with schizophrenia has following signs diseases:

• sudden change in behavior;
• unreasonable isolation;
• the appearance of hallucinations;
• frequent mood changes;
• aggressiveness towards others;
• severe anxiety;
• sleep disturbance;
• speech activity even in the absence of an interlocutor.

Severe symptoms of schizophrenia negatively affect a person’s overall well-being. In this state, he can pose a danger to himself and those around him. Therefore, he is prescribed treatment with drugs that reduce the intensity of painful symptoms.

Features of communication with the patient and his family

In unfavorable stages of a mental disorder, a nurse may be the only link connecting relatives and the patient

The medical staff conducts conversations not only with the patient, but also with his close relatives. It is he who should talk about the peculiarities of behavior next to the patient during periods of exacerbation of the disease and its remission.

In most patients who experience severe form schizophrenia, there is isolation from the world and aggressive behavior towards others. In such cases, nurses try to avoid long conversations with them, as this may cause them to become overly irritable. Ideally, you should limit yourself to a couple of conversations throughout the day, with intervals between them.

When communicating with patients, nurses should avoid general phrases. Specifics must be used in a conversation, otherwise a person may misunderstand the information that they are trying to convey to him.

The nurse must, through her actions, create the most comfortable conditions for the patient who is under her temporary care. She should avoid actions that are not provided for by the norms of behavior with patients diagnosed with schizophrenia.

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Lecture No. 4: Observation and care of patients with schizophrenia. Monitoring and caring for patients with affective mood disorders.

Mental disorders in schizophrenia. History of study; symptoms; syndromology; forms;

Types of flow; symptoms of schizophrenia from the perspective of ICD-10.

General principles of treatment. Features of observation and care. Medical rehabilitation.

Mental disorders in affective mood disorders.

Manic episode.

Bipolar affective disorder (BD).

Depressive episode.

Recurrent depressive disorder (RDD).

Chronic mood disorders.

Clinic. Principles of treatment. Features of observation and care. Medical rehabilitation.

SCHIZOPHRENIA,

Schizophrenia (from the gr. schizo - split, split, phren - soul, mind, reason) is a mental illness that occurs chronically in the form of attacks or continuous and leads to characteristic personality changes. It occurs in people predominantly young, 18-35 years old. Has a great social significance, since it affects mainly the working-age population.

SYMPTOMATICS

The clinical manifestations of schizophrenia are very diverse. Almost all existing conditions can be observed with this disease. psychopathological symptoms and syndromes.

The main symptoms of schizophrenia are: splitting mental activity, emotional-volitional impoverishment, in some cases - progression of the course.

With splitting of mental activity, patients gradually lose contact with reality; there appears a separation from the outside world, a retreat into oneself, into the world of one’s own painful experiences. This condition is called autism. Autism manifests itself in the form of a tendency to solitude, isolation, and inaccessibility to contact. The patient’s thinking is based on perverted reflections in the consciousness of the surrounding reality.

As the process progresses, the patient loses the unity of mental activity. Her inner disorder sets in. A striking example is the deep fragmentation of thinking in the form of “verbal crumbs”, schizophasia.

Symbolic thinking (symbolism) is also characteristic, when the patient explains individual objects and phenomena in his own, meaningful meaning only for him. For example, the letter “v” in quotation marks means the whole world to him; he perceives a drawing in the form of a ring with a human head as a symbol of his security; a cherry pit is regarded as loneliness; an unextinguished cigarette butt is like a dying life.

Due to a violation of internal (differentiated) inhibition, the patient experiences agglutination (gluing together) of concepts. He loses the ability to differentiate one concept, idea from another. As a result, new concepts and words appear in his speech - neologisms; for example, the concept of “gordestoly” combines the words wardrobe and table, “rakosvyazka” - cancer and bunch, “trampar” - tram and steam locomotive, etc.

Reasoning, or empty philosophizing, is quite common in the clinic of schizophrenia. (For example, the patient’s fruitless arguments about the design of the office table, the expediency of four legs for chairs, etc.).

Emotional-volitional impoverishment develops a certain time after the start of the process and is clearly expressed upon manifestation painful symptoms. This symptom is characterized by emotional dullness, affective indifference to everything around and especially emotional coldness towards loved ones and relatives! The patient may laugh during sad events and cry during joyful ones, or indifferently tell how during the funeral he wanted to pour kerosene on his mother and burn him. Emotional-volitional impoverishment is accompanied by lack of will - abulia. Patients do not care about anything, are not interested, they have no real plans for the future, or they speak about them extremely reluctantly, in monosyllables, without the desire to implement them.

Ambivalence is the duality of ideas and feelings that exist simultaneously and are oppositely directed.

Ambitiousness is a similar disorder, manifested in the duality of aspirations, motives, actions, and tendencies of the patient. For example, the patient declares that he loves and hates at the same time, considers himself sick and healthy, that he is God and the devil, a tsar and a revolutionary, etc.

Negativism is the desire to perform an action opposite to what is proposed. For example, when a patient is extended his hand to shake hands, he hides his own, and vice versa, if the giver removes his hand, then the patient holds out his own. Negativism is based on the mechanism of the ultraparadoxical phase, which arises in various fields mental activity of the patient.

The progression of the course of schizophrenia is characterized by a gradual complication of the symptoms of the disease, which develops continuously or in attacks. Gradually increasing negative signs illnesses and positive symptoms. The latter manifests itself in the form of various syndromes, clinical characteristics which depends on the form and stage of development of the process.

SYNDROMOLOGY

Schizophrenia is characterized by a number of syndromes that reflect the degree of progression and stages of development of the process. Most of its variants begin with the appearance of an asthenic symptom complex. manifested as hypo- or hyperesthesia. Patients complain of increased fatigue, irritability, headaches, sleep disturbances, and absent-mindedness.

Following asthenic disorders develop affective syndromes. They include hypomanic and subdepressive symptoms, in some cases accompanied by delusional ideas. Patients become sad, inhibited, express ideas of self-accusation, or, conversely, exhibit an unmotivated elevated mood.

As the process progresses, the following delusional syndromes are detected.

Paranoid syndrome includes systematized crazy ideas persecution, poisoning, jealousy, etc.

Hallucinosis is an influx of auditory (verbal) hallucinations. Hallucinosis indicates more severe course process. It can be true or false. In the first case, the patient perceives voices from environment. In pseudohallucinosis, voices are heard inside the head or one's own body.

Paranoid syndrome consists of unsystematized delusions, auditory, gustatory and olfactory hallucinations, depersonalization disorders, and often includes Kandinsky-Clerambault syndrome.

Paraphrenic syndrome is a combination of symptoms of previous syndromes, but in this case, the absurd delusion of grandeur, confabulatory delusion, comes to the fore.

Catatonic syndrome is one of the most severe symptom complexes found in schizophrenia. It manifests itself in the form of catatonic stupor or agitation with negativism, stereotypy of movements, “echo” symptoms, etc. The so-called secondary catatonia, which usually develops at the end of the disease process, is especially resistant to therapy. The exception is oneiric catatonia, which proceeds more favorably.

In the case of an unfavorable course of schizophrenia, a terminal (final) state of the disease is detected. At the same time, all the symptoms of the above syndromes are leveled out, lose their relevance, and deep intellectual degradation and emotional-volitional impoverishment of the personality come to the fore.

There are five main “classical” forms of schizophrenia: simple, hebephrenic, paranoid, catatonic and circular.

Simple schizophrenia usually occurs in adolescence and develops slowly. With it, negative disorders come to the fore. Emotional impoverishment, apathy, and difficulty in assimilating newly received information appear. Patients lose interest in activities and work, strive for solitude, do not get out of bed for a long time, are emotionally cold towards family and friends, complain about loss of thoughts, “emptiness in the head.” Patients do not have a critical attitude towards their condition.

Delusions and hallucinations are not characteristic of simple schizophrenia; if they appear, then only occasionally and in a rudimentary form (unstable ideas of relationship, persecution, auditory hallucinations in the form of calls by name, etc.).

The simple form of schizophrenia is usually malignant; in some cases, a course with a slow development of personality changes along the schizophrenic type is observed.

Hebephrenic schizophrenia is similar in its development to simple schizophrenia. It is also characteristic of adolescence and begins with the emotional-volitional flattening of the personality, with the appearance of intellectual disorders. However, with this form of the disease, along with negative disorders, there is foolishness, pretentious behavior, fussiness, stereotypical movements against the background of an unreasonably elevated mood. Patients tumble, jump, clap their hands, and grimace. Their speech is usually broken. In addition, sharply fragmentary delusional ideas and hallucinations with phenomena of mental automatism are observed.

This form of schizophrenia has an extremely unfavorable prognosis, is distinguished by its malignant course and the rapid development of profound dementia.

Paranoid schizophrenia usually develops in adulthood, usually between 30 and 40 years of age. The leading one here is a paranoid syndrome with the presence of delusional ideas about relationships, persecution, poisoning, and physical influence. Delusional statements are accompanied by hallucinatory disorders. The behavior of patients reflects delusional and hallucinatory experiences.

At paranoid form In schizophrenia, Kandinsky-Clerambault syndrome and depersonalization disorders are common. All types of delusions and hallucinations gradually fade and lose their relevance as the disease progresses; Symptoms of apathetic dementia come to the fore.

In catatonic schizophrenia, the symptoms of catatonic syndrome prevail with symptoms of “hood”, “waxy flexibility”, “air cushion” of Dupre, with muscle hypertension. In addition, delusional ideas, hallucinatory disorders, as well as emotional-volitional personality changes of the schizophrenic type are observed. It occurs between 22 and 30 years of age, less commonly at puberty. Patients lie in bed for days, sometimes months, without communicating with anyone, without speaking. Extremely negative, mannered; the facial expression is frozen. It should be noted that catatonic schizophrenia can occur with clear consciousness of patients (lucid catatonia) and with a sleep-like disorder of consciousness (oneiric catatonia).

Circular schizophrenia often develops in middle-aged people. Its clinical picture consists of periodically occurring manic, then depressive phases with the inclusion of hallucinatory and hallucinatory-delusional disorders, as well as Kandinsky-Clerambault syndrome. There is insufficient emotional intensity of manic and depressive attacks. The disease progresses relatively favorably.

TYPES OF FLOW

A.V. Snezhnevsky and R.A. Nadzharov (1968 - 1970) identified three types of schizophrenia: continuous, paroxysmal-progressive (fur-like; from German schub - shift, attack) and periodic.

1. Continuous schizophrenia is characterized by the absence of autochthonous, spontaneous remissions. The disease exhibits a large polymorphism of symptoms.

2. Sluggish schizophrenia occurs at 16 - 18 years of age, sometimes even at childhood. The later the process begins, the smoother it proceeds. Symptoms of sluggish schizophrenia are usually limited to a range of small syndromes: neurosis-like, hysteroform, psychopath-like, paranoid with overvalued formations and delusional ideas of relationships. The course of this variant varies, but most often it is uneven. At first, symptoms develop quickly, then the process proceeds slowly and is accompanied by ups and downs mental disorders.

3. Schizophrenia with an average (paranoid) type of progression usually begins sluggishly, with neurosis-like disorders, at the age of 20 - 40 years. Sometimes there is more early development, in adolescence. Leaking paranoid schizophrenia in this case it is more malignant.

Already at the very beginning of the disease, personality traits appear that are striking to others: isolation, emotional inadequacy, limited range of interests. Occasionally there is anxiety, restlessness, and a feeling of dissatisfaction.

Subsequently, a paranoid syndrome develops, and from this moment on, the manifestation of the disease is dominated by delusional ideas (persecution, physical pressure, jealousy, etc.).

Malignant (juvenile) schizophrenia occurs in adolescence, less often in childhood, much more often in boys than in girls.

The disease begins with negative disorders: the vitality of interests is lost, becomes impoverished emotional sphere, isolation appears. Patients exhibit unmotivated pretentious hobbies in philosophy and religion.

With the development of the disease, polymorphic productive symptoms appear: sharply fragmentary delusional ideas of various contents, catatonic and hebephrenic disorders, phenomena of Kandinsky-Clerambault syndrome, disturbance of the body diagram, etc.

After 2-5 years, a deep personality defect, emotional dullness, and abulia develop.

Symptoms in malignant schizophrenia are highly resistant to therapy.

4. Paroxysmal-progressive (coat-like) schizophrenia occurs in the form of attacks with subsequent remissions. But the reverse development of the attack does not end full restoration mental health: obsessive, hypochondriacal and paranoid disorders remain. From attack to attack, the patient increasingly shows a flattening of the emotional-volitional sphere. In fur-like schizophrenia, attacks are emotionally colored, delusional ideas are not systematized.

5. In periodic (recurrent) schizophrenia, the autochthonous tendency towards a phase course is especially clearly revealed. Remissions are always deep and are accompanied by a complete reverse development of productive psychotic symptoms.

ICD-10 diagnostic criteria

According to ICD 10, at least one of the following signs must be detected:

Echo of thoughts (the sound of one’s own thoughts), insertion or removal of thoughts, transmission of thoughts over a distance.

Delirium of mastery, influence, inaction relating to the entire body (or limbs), thoughts, actions or sensations; delusional perception.

Persistent delusional ideas that are culturally inappropriate, ridiculous and grandiose in content. Or at least two of the following signs:

Chronic (more than a month) hallucinations with delusions, but without pronounced affect.

Neologisms, broken speech.

Catatonic behavior such as agitation, rigidity or waxiness, negativism, mutism and stupor.

Negative symptoms (not caused by depression or treatment with antipsychotics) severe:

Poverty or inadequacy of emotional reactions.

Social isolation.

Social unproductivity.

Reliable and pronounced changes in the general quality of behavior, manifested by:

Loss of interests

Aimlessness.

Absorption in one's own experiences, autism.

When symptoms of schizophrenia develop together with severe symptoms of other disorders (affective, epileptic, other brain diseases, intoxication with drugs and psychoactive substances), the diagnosis of schizophrenia is not made, and the appropriate diagnostic categories and codes are used.

Schizophrenia in childhood.

All the various manifestations of schizophrenia in children and adolescents can be grouped into the four most typical psychopathological conditions, characteristic to a certain extent for all forms of schizophrenia.

Pathological (delusional) fantasizing - observed mainly in children up to school age.

Pathological fantasizing at the beginning of its appearance is almost no different from the usual fantasies of a child, but later it acquires a character completely divorced from reality and is often associated with deceptions of feelings. The child begins to get along with the characters of his fantasy world, in which he is allowed everything that is inaccessible to him in ordinary life. He lives the stereotypical life of a game, which is diametrically opposed to the surrounding reality. In his fantasies, the child tries to realize his unrealistic dreams. real life aspirations, dreams of power, the discovery of unknown countries, is interested in inventions, questions of a philosophical nature - what is life, time, who are people, etc. Claiming (fantasizing) that he is a hare or a horse, the child refuses regular food and may demand grass, hay, grain, etc.

Abulia in school-age children is observed in a pronounced form.

In this case, the child becomes lethargic and apathetic, ceases to show his previously characteristic activity, withdraws into himself, becomes inaccessible and incomprehensible to others. Tendency to long-term inactive existence, increasing lethargy, decreased mental activity, a sharp drop in performance - like chronic fatigue

are early characteristic features schizophrenia.

As a rule, parents and teachers regard abulia as a manifestation of laziness. In reality, this is not laziness, but the beginning of a schizophrenic process. Over time, the decrease in activity becomes more and more pronounced. The child stops fulfilling his duties, is not interested in anything, is aimless

wanders around the house from corner to corner, stays in bed for hours or days, has no drives and desires, refuses to visit kindergarten or school, does not communicate with family and friends, becomes sloppy. A decrease in volitional activity leads to the fact that the child stops performing even the simplest actions (for example, if he is not offered food, he may not take it, lying in bed all day long.) Along with violations of volitional activity, unmotivated, absurd actions of an impulsive child are often observed. type. Unexpectedly in the background calm state a sick child may scream loudly, unexpectedly hit an adult or kiss stranger, curse cynically, persistently strive for the realization of an absurd desire. These phenomena are often accompanied by hypochondriacal, delusional ideas of influence and hallucinations. In most cases they are unstable and fragmentary.

Emotional dullness is one of the constant and most characteristic manifestations of schizophrenia. Due to the increasing fading of emotions, the sick child loses contact with others, becomes indifferent to what in the past formed the basis of his interests, shows indifference to family and friends, to his life. The patient loses his sense of tact, rudeness and shamelessness appear, an explosion of rage occurs at the slightest insignificant reason, and, on the contrary, no response is manifested to the influence of a strong stimulus, the patient has no relationship between affect and intellect. In advanced, protracted cases, a sharp disturbance of emotions is observed, affective ambivalence is transformed into emotional dullness. The patient loses the brightness and spontaneity of his experiences, nothing interests him, does not make him happy, does not sadden him, that is, as the disease progresses, emotional reactions acquire the character of complete indifference, impoverishment of feelings and emotional dullness increases.

Splitting (fractured) thinking is a symptom typical of any form of schizophrenia. It is characterized by a separation of thinking from reality, a tendency towards fruitless philosophizing and symbolism. Some patients talk a lot, others stop talking altogether or carefully repeat individual words or phrases, stringing them together in disarray. Their speech is replete with new words not found in everyday life. Written speech is dominated by elaborate letters, curlicues, underlining, an abundance of punctuation marks and symbolic notations, etc.

Main forms of schizophrenia in children and adolescents.

There are several forms of schizophrenia in children and adolescents. A.I. Seletsky identifies the following:

Catatonic form

In some cases, it is characterized by increasing isolation, detachment from the surrounding reality and depression, but more often it is characterized by catatonic excitement, turning into stupor, severe muscle tension, freezing in bizarre poses, immobility, negativism and refusal of food and speech contact.

In acute cases, the disease is limited

several attacks of stupor and agitation and recovery occurs. In the chronic course of schizophrenia, the patient experiences increasing symptoms of lethargy and lethargy with rare long-term remissions, mental changes occur in the form of affective devastation and increasing dementia. Thus, with this form of schizophrenia, both long-term remissions and complete recovery are characteristic.

Hebephrenic or juvenile form of schizophrenia

It is characterized by a slow course of schizophrenia and is observed in high school and adolescence. The disease begins gradually, with the appearance of complaints of absent-mindedness, acute headache and insomnia. Months and even years may pass after the onset of such complaints, so people around the patient often cannot determine the time of onset of the disease. The leading sign of the disease is foolishness with unmotivated fun and motor agitation. Constant symptoms This form of the disease is absurd gaiety with mannerisms, traits of foolishness, the same absurd antics, a tendency to eccentricity, grimacing and antics.

Simple form of schizophrenia

It begins at any age, but is more common in childhood and less common in adolescence. The leading signs of the disease are a progressive loss of interests, increasing lethargy, emotional indifference, isolation and a decrease in indicators related to intelligence. Occasionally, hallucinations and a paranoid state occur, accompanied by malicious aggressiveness towards family and friends, who usually persistently demand that the child attend school. Patients leave home, spend time wandering aimlessly through the streets, and become involved in antisocial behavior.

Vaccinated form of schizophrenia

It is observed in children and adolescents who have in the past suffered any organic brain damage that caused a delay in mental development, predominantly oligophrenia. Before the onset of the disease, the child’s personality was characterized by the following features: capricious stubbornness, isolation, outbursts of irritability, past illnesses unexplained etiology, diathesis, intoxication, traumatic brain injury, etc. Thus, schizophrenia is grafted onto biologically altered soil, which significantly complicates the course pathological process and leads, especially when the disease occurs in early childhood, to a stop in mental development.

The course and outcome of these forms of schizophrenia can end with recovery, long-term remission, and apathetic dementia.

In the last decade, significant advances have been made in the treatment of schizophrenia. There are many different therapeutic techniques, sometimes allowing patients even with a severe psychopathological picture to achieve significant improvement.

All types drug treatment schizophrenia must be combined with psychotherapeutic interventions. Patients should be involved in work, properly organizing their regimen during treatment both in the hospital and at home.

Currently, psychotropic drugs are widely used, as well as comatose treatment methods (insulin, atropinocomatose, electroconvulsive therapy).

The choice of certain treatment methods depends on the form, type of course and duration of the disease and on the structure of the leading syndrome.

If there is an acute hallucinatory-delusional syndrome in the clinical picture, antipsychotics with a predominantly inhibitory effect are prescribed in rapidly increasing dosages (aminazine -1 - 400 mg, tizercin - 250 - 400 mg, trisedyl - 2 - 5 mg, triftazine - 40 - 60 mg per day and etc).

For the catatonic form of schizophrenia, mazeptil (up to 150 mg per day) is indicated, for simple schizophrenia - frenolone (up to 80 - 120 mg per day).

The presence of depressive symptoms in the clinical picture requires additional prescription of antidepressants (melipramine - up to 75 - 150 mg, amitriptyline - up to 100 - 150 mg or pyrazidol - up to 150 mg per day in gradually increasing dosages).

Other psychotropic drugs are also indicated, including long-acting drugs; one should also forget about correctors - cyclodol, artane, parkopan, romparkin, dynesin, norakin, etc.

Upon reaching therapeutic effect Patients with schizophrenia are prescribed anti-relapse treatment psychotropic drugs(better with long-acting drugs - moditene-depot fluspirilen). At the same time they carry out rehabilitation measures on their social and labor structure, providing psychotherapeutic assistance, as well as on improving the microsocial environment.

To the number preventive measures should include the need for patients to observe the correct hygienic regime of work and life, maintaining healthy image life. Physical and mental fatigue, all kinds of psychogenic injuries and, especially, a state of prolonged forced stress can provoke a relapse. Exacerbation of the process can be facilitated by various intoxications and infections.

In many forms of schizophrenia, behavioral disturbances and increased pathological activity are often found. However, serious physical violence against others, much less murder, is rare. If the patient’s symptoms include delusional ideas of persecution, influence, along with auditory hallucinations (especially imperative ones), self-harm and suicidal attempts are possible. About one in ten people with schizophrenia die by suicide.

In forensic psychiatric assessments of patients with schizophrenia, subjects are usually declared insane. In cases where a schizophrenic disorder or a sluggish process is diagnosed, the issue is resolved individually.

Affective mood disorders.

Mood disorders include wide range mental abnormalities, most often manifested either in a pathologically low mood - a depressive episode, or in its painful increase - a manic episode. When a patient suffers repeated episodes of depression (but not mania) - recurrent depressive disorders, but if at least one episode of mania or hypomania was noted during the course of the disease - this is bipolar affective disorder.

Bipolar affective disorder (formerly manic-depressive psychosis) is a mental disorder manifested by affective states - manic (hypomanic) and depressive, as well as mixed states in which the patient experiences symptoms of depression and mania at the same time (for example, melancholy with anxiety, anxiety , or euphoria with lethargy, so-called unproductive mania), or a rapid change in symptoms of (hypo)mania and (sub)depression.

These states periodically, in the form of phases, directly or through “bright” intervals of mental health (the so-called interphases, or intermissions), replace each other, without or almost without a decrease in mental functions, even with a large number of phases experienced and any duration of the disease. Clinical picture, course

Debut of bipolar affective disorder occurs more often at a young age - 20-30 years. The number of phases possible for each patient is unpredictable; the disorder can be limited to only one phase (mania, hypomania or depression) throughout life, can manifest itself only in manic, only hypomanic or only depressive phases, or in their alternation with correct or incorrect alternation.

The duration of the phases ranges from several weeks to 1.5-2 years (on average 3-7 months), the duration of “light” intervals (intermissions or interphases) between phases can range from 3 to 7 years; the “light” gap may be completely absent; Atypicality of phases can be manifested by disproportionate severity of core (affective, motor and ideation) disorders, incomplete development of stages within one phase, inclusion in the psychopathological structure of the phase of obsessive, senestopathic, hypochondriacal, heterogeneous-delusional (in particular, paranoid), hallucinatory and catatonic disorders.

Course of the manic phase

The manic phase is represented by a triad of main symptoms:

Elevated mood (hyperthymia),

motor excitement,

Ideatorial-psychic (tachypsychia) excitation.

There are five stages during the manic phase.

The hypomanic stage (F31.0no ICD-10) is characterized by elevated mood, the appearance of a feeling of spiritual uplift, physical and mental vigor. Speech is verbose, accelerated, the number of semantic associations decreases with an increase in mechanical associations (by similarity and consonance in space and time). Characterized by moderately expressed motor agitation. Attention is characterized by increased distractibility. Hypermnesia is characteristic. Sleep duration is moderately reduced.

The stage of severe mania is characterized by a further increase in the severity of the main symptoms of the phase. Patients constantly joke and laugh, against which short-term outbursts of anger are possible. Speech excitement is pronounced, reaching the level of racing ideas (lat. fuga idearum). At work, patients build rosy prospects, invest money in unpromising projects, and design crazy designs. Sleep duration is reduced to 3-4 hours a day.

The stage of manic frenzy is characterized by the maximum severity of the main symptoms. Severe motor arousal is chaotic in nature, speech is outwardly incoherent (during analysis it is possible to establish mechanically associative connections between the components of speech), consists of fragments of phrases, individual words or even syllables.

The stage of motor calming is characterized by a reduction in motor excitation against the background of persistent elevated mood and speech excitation. The intensity of the last two symptoms also gradually decreases.

The reactive stage is characterized by the return of all components of the symptoms of mania to normal and even a slight decrease in mood compared to normal, mild motor and ideational retardation, and asthenia. Some episodes of the stage of severe mania and the stage of manic frenzy in patients may be amnesic.

The course of the depressive phase

The depressive phase is represented by a triad of symptoms opposite to the manic stage: depressed mood (hypotymia), slow thinking (bradypsychia) and motor retardation. In general, bipolar disorder is more often manifested by depressive symptoms than manic states. There are four stages during the depressive phase.

The initial stage of depression is manifested by a mild weakening of the general mental tone, decreased mood, mental and physical performance. Characterized by the appearance of moderate sleep disorders in the form of difficulty falling asleep and its superficiality. All stages of the depressive phase are characterized by an improvement in mood and general well-being in the evening hours.

The stage of increasing depression is characterized by a clear decrease in mood with the appearance of an anxious component, sharp decline physical and mental performance, motor retardation. Speech is slow, laconic, quiet. Sleep disturbances result in insomnia. Characterized by a noticeable decrease in appetite.

Stage of severe depression - all symptoms reach their maximum development. Severe psychotic affects of melancholy and anxiety are characteristic, painfully experienced by patients. Speech is sharply slow, quiet or whispered, answers to questions are monosyllabic, with long delay. Patients can sit or lie in one position for a long time (the so-called “depressive stupor”). Anorexia is characteristic. Suicidal attempts are most frequent and dangerous at the beginning of the stage and at the end of it, when, against the background of severe hypothymia, there is no pronounced motor retardation. Illusions and hallucinations are rare.

The reactive stage is characterized by a gradual reduction of all symptoms, asthenia persists for some time, but sometimes, on the contrary, there is some hyperthymia, talkativeness, increased physical activity.

Variants of the course of bipolar affective disorder:

Periodic mania - only manic phases alternate;

Periodic depression - only depressive phases alternate;

Correctly intermittent type of flow - through “light” intervals, the manic phase replaces the depressive phase, and the depressive phase replaces the manic phase;

Incorrectly intermittent type of course - through “light” intervals, manic and depressive phases alternate without strict order (after the manic phase, the manic phase may begin again and vice versa);

Double form - a direct change of two opposite phases, followed by a “light” interval;

Circular type of flow - there are no “light” gaps.

The most common types of course: irregularly intermittent type and periodic depression.

Depressive phase

Of decisive importance in the treatment of the depressive phase of bipolar disorder is an understanding of the structure of depression, the type of course of bipolar disorder as a whole, and the patient’s health status.

Treatment with antidepressants must be combined with mood stabilizers - mood stabilizers, and even better with atypical antipsychotics. The most progressive is the combination of antidepressants with atypical antipsychotics such as olanzapine, quetiapine or aripiprazole - these drugs not only prevent phase inversion, but also have an antidepressant effect. In addition, olanzapine has been shown to overcome resistance to serotonergic antidepressants: now available combination drug- olanzapine + fluoxetine - Symbyax.

Manic phase

The main role in the treatment of the manic phase is played by mood stabilizers (lithium drugs, carbamazepine, valproic acid, lamotrigine), but to quickly eliminate symptoms there is a need for antipsychotics, with priority given to atypical ones - classical antipsychotics can not only provoke depression, but also cause extrapyramidal disorders, to which patients with bipolar disorder are especially predisposed and, especially, to tardive dyskinesia - an irreversible disorder leading to disability.

Prevention of exacerbations of bipolar disorder.$

For the purpose of prevention, mood stabilizers are used. These include: lithium carbonate, carbamazepine (Finlepsin, Tegretol), valproates (Depakine, Konvulex). It is worth noting lamotrigine (Lamictal), which is especially indicated for rapid cycling with a predominance of depressive phases. Atypical antipsychotics are very promising in this regard, and olanzapine and aripiprazole have already been approved in a number of developed countries as mood stabilizers for bipolar disorder.

Depression. Involitional psychoses.

/F32/ A depressive episode is a state of depression experienced by a person for the first time in his life. There are mild depressive episodes, moderate depressive episodes, and severe depressive episodes. Main symptoms of depression:

the patient suffers from low mood, loss of interests and pleasure,

decreased energy levels, which can lead to increased fatigue and reduced activity. There is marked fatigue even with little effort. Other symptoms include:

a) reduced ability to concentrate and pay attention;

b) decreased self-esteem and sense of self-confidence;

c) ideas of guilt and humiliation (even with a mild type of episode);

d) gloomy and pessimistic vision of the future;

e)ideas or actions aimed at self-harm or suicide;

e) disturbed sleep;

g) decreased appetite.

Low libido, menstrual irregularities

i) heart pain, tachycardia, blood pressure fluctuations, constipation, dry skin

Diagnostic instructions:

A mild depressive episode is characterized by:

For a definite diagnosis, at least 2 of these 3 main symptoms are required, plus at least 2 more of the other symptoms described above (for F32). None of these symptoms should be severe, and the minimum duration of the entire episode should be approximately 2 weeks.

A moderate depressive episode is characterized by: the presence of at least 2 of the main symptoms, plus 3-4 of the other symptoms, and the symptoms are so severe that the patient experiences difficulty performing professional and household responsibilities, and the minimum duration of the entire episode is approximately 2 weeks .

A major depressive episode is characterized by:

The presence of 3 main criteria, plus 4 or more other signs, and at least some of them are severe. The patient cannot perform even simple household chores. Duration 2 or more weeks.

/EDZ/ Recurrent depressive disorder

A disorder characterized by repeated episodes of depression without anamnestic evidence of individual episodes of elevated mood, hyperactivity, which could meet the criteria for mania (F30.1 and F30.2x). The age of onset, severity, duration, and frequency of depressive episodes vary widely. In general, the first episode occurs later than in bipolar depression: on average in the fifth decade of life. The duration of episodes is 3-12 months (average duration is about 6 months), but they tend to recur less frequently. Although recovery is usually complete in the interictal period, a small proportion of patients develop chronic depression, especially in old age (this category is also used for this category of patients). Individual episodes of any severity are often provoked stressful situation and in many cultural conditions are observed 2 times more often in women than in men.

The risk that a patient with a recurrent depressive episode will not have a manic episode cannot be completely excluded, no matter how many depressive episodes there have been in the past. If an episode of mania occurs, the diagnosis should be changed to bipolar affective disorder.

Chronic mood disorders - when the patient's mood disorders persist almost constantly, without clear intervals, but their severity is low. These disorders include cyclothymia and dysthymia.

Dysthymia

Clinical picture of dysthymia

Dysthymia is characterized by chronic nonpsychotic signs and symptoms of depression that meet specific diagnostic criteria but do not meet criteria for mild depressive disorder. Dysthymia is characterized by a chronic course without intervals, during which there are no pathological symptoms.

Appearance and behavior of the patient. These patients exhibit introversion, gloominess, and low self-esteem. Patients are characterized by many somatic complaints. The main symptom is a feeling of sadness, seeing the world in a black light, and a decrease in interests. Patients with dysthymia can be sarcastic, nihilistic, brooding, demanding, and complaining. Such patients often have difficulties in interpersonal relationships: with colleagues at work, in family life. Possible alcohol abuse.

Diagnostic criteria (the diagnosis is made if there is 1 sign and at least three listed under point 2)

Depressed mood for at least 2 years (1 year for children and adolescents), the period of absence of symptoms should not exceed two months.

The presence of at least two factors:

poor appetite

insomnia/drowsiness

low energy, fatigue

decreased attention

feeling of hopelessness

Absence obvious attack severe depressive disorder for 2 years (for children and adolescents - for 1 year).

No episode of mania or hypomania

Cyclothymia is a milder form of bipolar disorder, in which the patient, without connection with external events, experiences a constant alternation of periods of slightly depressed and slightly elevated mood. Manic episode

A manic episode is a combination of elevated mood, increased tempo of thinking, and increased motor activity.

Patients' appearance often reflects an elevated mood. Patients, especially women, tend to dress brightly and provocatively, and use cosmetics excessively. The eyes are shiny, the face is hyperemic, and when talking, splashes of saliva often fly out of the mouth. Facial expressions are lively, movements are fast and impetuous, gestures and postures are emphatically expressive.

High spirits are combined with unshakable optimism. All the experiences of patients are painted only in rainbow tones. Patients are carefree and have no problems. Past troubles and misfortunes are forgotten, the future is painted only in bright colors.

Increased motor activity - patients are constantly on the move, cannot sit still, walk, interfere in everything, try to command the patients, etc. During conversations with a doctor, patients often change their position, spin, jump up, begin to walk and often even run around the office.

Acceleration of the pace of thinking - patients talk a lot, loudly, quickly, often without stopping. With prolonged speech stimulation, the voice becomes hoarse. The content of the statements is inconsistent. Easily move from one topic to another. With increasing speech excitement, a thought that does not have time to finish is already replaced by another, as a result of which statements become fragmentary (“jump of ideas”). The speech alternates with jokes, witticisms, puns, foreign words, and quotes.

Sleep disturbances manifest themselves in the fact that patients sleep little (3-5 hours a day), but at the same time they always feel cheerful and full of energy.

With manic syndrome, an increase in appetite and increased sexual desire are almost always noted.

Expansive ideas. The possibilities for realizing numerous plans and desires seem limitless to patients; patients do not see any obstacles to their implementation. Expansive ideas easily turn into expansive delusions, which are most often manifested by delusional ideas of greatness, invention and reform.

In severe manic syndrome, hallucinations are noted (rarely). Auditory hallucinations usually praising content (for example, voices tell the patient that he great inventor). At visual hallucinations the patient sees religious scenes.

The hypomanic state (hypomania) is characterized by the same features as severe mania, but all symptoms are smoothed out, and there are no gross behavioral disturbances leading to complete social maladjustment. Patients are active, energetic, prone to jokes, and overly talkative. The increase in their mood does not reach the level of conspicuous indomitable gaiety, but is manifested by cheerfulness and optimistic faith in the success of any undertaking. Many plans and ideas arise, sometimes useful and reasonable, sometimes overly risky and frivolous. They make dubious acquaintances, are promiscuous sex life, begin to abuse alcohol, and easily take the path of breaking the law.

Also distinguished:

mania without psychotic symptoms: The episode lasts more than 1 week and the symptoms are so severe that they interfere with the patient's professional and social activities.

Mania with psychotic symptoms: in patients along with characteristic manifestations delusions, hallucinations and catatonic manifestations are noted.

TREATMENT Basic principles:

Combination drug therapy with psychotherapy

Individual selection of drugs depending on the prevailing symptoms, effectiveness and tolerability of the drugs. Prescribing small doses of drugs with a gradual increase

Prescription for exacerbation of drugs that were previously effective

Review of the treatment regimen if there is no effect within 4-6 weeks Treatment of depressive episodes

TAD - amitriptyline and imipramine.

Selective serotonin reuptake inhibitors. The drugs are prescribed once in the morning: fluoxetine 20-40 mg/day, sertraline 50-100 mg/day, paroxetine 10-30 mg/day.

MAO inhibitors (for example, nialamide 200-350 mg/day, preferably in 2 doses in the morning and afternoon

Electroconvulsive therapy (ECT). Clinical researches showed that the antidepressant effect of ECT develops faster and is more effective in patients with severe depressive disorder with delusional ideas than when using TAD. Thus, ECT is the method of choice in the treatment of patients suffering from depressive disorder with psychomotor retardation and delirium when drug therapy is ineffective.

Ostapyuk L.S.
Pevzner T.S.

Schizophrenia- a mental illness that most often develops at a young age.

There are a number of known forms of schizophrenia. In some forms, the behavior of patients is dominated by lethargy, inactivity, and passivity. Patients are indifferent to their surroundings, indifferent to everything, they spend the whole day in bed, often turning their face to the wall. They are sloppy, do not take care of themselves, their suit, hairstyle, appearance, do not wash their face, do not change their underwear. Their appetite is low and their sleep is poor. All attempts to come into contact with the patient and bring him out of this state are met with a negative reaction on his part, sometimes quite pronounced. If insomnia increases, it always serious symptom deterioration, which cannot be ignored, especially if this is also accompanied by a reluctance to eat. Then you have to contact a psychiatrist, who most often refers the patient to the hospital.

But if the condition is not yet too severe, or if after discharge from the hospital it fluctuates, sometimes worsening, sometimes improving, but remains generally tolerable, then how to care for such patients?

First of all, it is important to ensure that supportive drug treatment. It is necessary to ensure that patients take their prescribed medications in recommended dosages. Then the improvement achieved in the hospital is more durable, the patient stays at home, is less likely to be admitted to the hospital, but any hospitalization is an unnecessary trauma for the patient and his relatives.

When the patient has just been discharged, his condition is good or satisfactory, contact with him is easier and the influence of the doctor, whom he trusts and whose recommendations he is inclined to take into account, is still strong, then it is easier to organize the medication.

Please note that after checking out good condition, the patient believes that he is already healthy and can do without the medicine that bothers him. Here you need to use all the influence of the family and others to prevent a break in taking medications and to convince the patient that this can cause a deterioration in the condition. The main thing is that the relatives themselves must become aware of the need for so-called supportive treatment.

It is important to keep in mind that as soon as the disease worsens or worsens, patients refuse to take medications. Sometimes they refuse for delusional reasons, not trusting relatives, fearing that they will be poisoned, killed, etc., or consider themselves healthy. This causes an exacerbation of the disease and influences the patient’s behavior, making it more and more difficult to regulate.

If you can’t persuade someone to take the medicine, then you need to administer it with food: crushed medicine (if it’s tablets) can be poured into jelly, porridge, or soup. It is important to achieve the first few techniques, because they already improve the patient’s condition, soften tension and insubordination. Next, you can count on improving the patient’s contact with others. If these attempts are unsuccessful, then it is necessary to notify the local psychiatrist, who has the ability to provide effective forms treatment (intramuscular, intravenous administration drugs).

A lot of attention from others to the patient is needed, especially from those who are closest to him and whom he trusts most. It is important not to overlook the increasing exacerbation of the disease, the emergence of thoughts of suicide, and to always be on guard. Timely admission to the hospital and, consequently, increased treatment will improve the patient's condition, and the danger of suicide will disappear.

You should know that patients most often lose their professional ability to work and receive a second or third group disability. In the second group, they can work at home, in the third - in an institution for disabled people. It is also possible to find employment in occupational therapy workshops at a psychoneurological dispensary.

One of the difficult tasks that relatives face is the need to break through the apathy that engulfs the patient, or to prevent its intensification, to at least interest the patient in something, to use every opportunity to keep the patient busy with work. Trips outside the city - to the dacha, to the village - and involving the patient in physical work around the house, around the yard, on the site (removing snow, clearing paths), any work in the garden, in the garden are very useful. It is not recommended to work in the sun for a long time with your head uncovered. It is important that the work has meaning and is useful, otherwise patients will not do it.

There is a direct connection between systematically adjusted medication intake and the ability to attract the patient to work. And if you manage to attract him to work, then general state, as a rule, noticeably improves, which in turn makes it easier to take medications.

In addition, and this is very important, by participating in reasonable work and seeing its results, patients cease to feel inferior, useless in the family, and a burden. This goes a long way towards improving mental state and stability of the light gap. Sometimes it seems to relatives that they need to try to entertain the patient, invite guests and friends to him, advise him to go out to the cinema, etc. All this is undesirable, because often, along with lethargy and apathy, there are also delusional ideas. It seems to patients that everyone knows about their mental disorder, looks at them in a special way, and laughs at them. Communication with strangers can sometimes strengthen the patient in these delusional experiences.

Of course, all the symptoms of this form of schizophrenia are not always immediately expressed in the behavior of patients, but it is necessary to know about them.

Often, with favorable treatment results, patients regain their professional ability to work; they need employment without restrictions. But it happens that the painful delusional experiences of patients are associated with their work, with individual colleagues. Then, despite the improvement, patients avoid returning to work, where, among other things, there are eyewitnesses of their incorrect behavior and where there may simply be people who are not entirely friendly. In these cases, the question of changing jobs arises. This issue must always be resolved with the participation of a psychiatrist.

Relatives should be clearly aware of the importance of this issue and under no circumstances leave it to the discretion of the patients themselves. It is necessary to have contact with one of the patient’s colleagues, preferably with the immediate superior. Then you can influence the attitude towards the patient, prevent any misunderstandings, etc. If it turns out that the patient copes with his work and the attitude towards him is favorable, then, of course, it is advisable to persuade him to remain at his previous usual job. It must be made clear that continuing the usual work will not require additional effort, adaptation, acquisition of new skills, etc., that is, there will be no need for unnecessary stress, which is always undesirable. In addition, we must try to explain to the patient that those in the previous place already know about his illness and are inclined to take it into account.

It’s another matter if it is known that the attitude at work towards the patient is negative, that the administration will willingly fire him, that he has alienated the entire team. Then, of course, there is no need to return to the same place. In a new place there is no need to try to hide the disease, since sooner or later it will become known. It is usually best to report this to the supervisor with whom the patient will be working. This is also important because sometimes it is from work that the first signals about the incorrect behavior of patients during an exacerbation of the disease come.

We must also take into account the fact that in the family to which the patient returns after treatment, there are people with different degrees of relationship, some closer, others further away and not relatives at all: daughters-in-law, daughters-in-law, sons-in-law, etc., everyone has different characters and, Of course, not all of them treat the patient the same, and sometimes they are simply afraid of him. People with little culture and a bad character often tease the sick, call them crazy, grimace in their faces, make offensive gestures, hinting at madness, etc. There is no need to explain that all this is absolutely unacceptable and senselessly cruel. No matter how successful the treatment in the hospital is, no matter how good the patient is discharged, if he is greeted like this at home, an exacerbation of the disease will inevitably occur.

We observed a patient who had a very gentle mother, who treated her attentively and carefully. Upon her daughter’s return from the hospital, she usually prepares some work for her to clean the apartment, encourages her to sew new dresses for her and herself, knit blouses, etc. She always knows how to convince the patient that there is nothing terrible about her illness, as do others they are so sick that everything turned out fine for her and none of those around her know about her illness, no one pays attention to her, she is like all other people, etc. Gradually, the mother manages to soften all these experiences, and life seems to be getting better. A week passes, then another, when suddenly the patient’s sister’s husband, upon meeting her, begins to unequivocally twirl his finger on his temple. The patient cries, leaves home, wanders around the city, does not want to return, says that she does not want to live. It is necessary to place the patient in a hospital and begin treatment again.

Such a stupid and unkind family member has been interfering with the treatment of the patient for several years and, in essence, does not allow her to live at home. Sometimes one of the neighbors plays such an unflattering role, or children, imitating adults, repeat their rash actions.

It is necessary to use all ways and means of influence on such relatives and neighbors, and first of all you should contact a psychoneurological dispensary, where a local nurse should come to the rescue.

Currently, most families with mentally ill people receive separate apartments, and the “problem” of neighbors is gradually disappearing. But the task of establishing correct relationships between the patient and relatives will always take place.

Of course, everything must be done to create a normal environment for the patient in the family, but the patient should not be allowed to disrupt the entire course of life in the family and traumatize everyone else with his incorrect behavior and delusional accusations. If there are signs of an exacerbation of the disease or the patient’s condition remains consistently poor, then there is no need to hide it or try to smooth everything over. The exacerbation of the disease is an objective thing and, unfortunately, no amount of the best intentions can eliminate it. If the condition is poor, the patient’s interests require an early visit to a doctor to begin inpatient or ambulatory treatment under the supervision of a doctor.

Sometimes relatives begin to share the delusional accusations of their loved ones, and so-called family inspired psychosis occurs. It is necessary to show complete objectivity and not lose common sense in assessing patients’ complaints and consider them unfounded if there are no real grounds for them.

Thus, one patient, having fallen ill, believed that her neighbor was pouring some kind of detergent into her pots in order to gradually poison her and then take over her room. When the patient ate at home, she immediately felt bad, everything started to hurt, she felt nauseous and had some unpleasant sensations in her stomach. She became excited, blushed, sweated, and her heart began to pound—all the accompaniments of fear. The patient’s daughter, a 16-year-old schoolgirl, seeing how poorly her mother was feeling, was imbued with her delirium and had no doubt that the neighbor was really poisoning her: she also began to be afraid to eat at home, persuaded her mother to eat in the dining room, begged her to change apartments, and hated everything. than an innocent neighbor. The neighbor, realizing that this was psychosis, turned to a psychiatrist. The sick woman was placed in a medical institution, where she was treated for a long time, and she had to have several conversations with her daughter until she understood everything correctly.

Under the influence of delusional experiences, patients sometimes insist on exchanging an apartment, because they mistake their neighbors for their enemies, who, as it seems to them, threaten their lives, spread defamatory information about them, monitor their every move, and inform the institution where they work about everything. , etc. At the same time, patients agree to any exchange, sometimes worsening their housing and living conditions, just to “save” themselves as quickly as possible. Even if the patient’s relatives understand that the patient is in the grip of painful delusional experiences, it still often seems to them that if they change their apartment and neighbors, the patient will get rid of his delirium and begin to live in peace. Therefore, relatives of patients often do not object to the exchange and even promote it.

You should never make serious changes in a patient’s life without consulting a psychiatrist, because they, as a rule, do not achieve their goal, since they are made for reasons of a painful nature, and not for reasons common sense. In the new apartment, patients feel that the previous neighbors have established a connection with the new ones and new apartment information comes in that defames them. This, in their opinion, immediately changed the attitude of their new neighbors towards them: they became hostile, it was impossible to live as before, it was necessary to look for a new exchange, a new apartment. This can happen endlessly, because it’s not about the apartment, but about the disease that needs to be treated.

In different forms of schizophrenia, certain signs of the disease are presented and expressed differently. In one of the forms, delusions and hallucinations predominate. Often, hallucinations seem to reinforce delusions: the voices that the patient hears strengthen his delusional ideas and thoughts, and develop them. The voices express thoughts and threats hostile to the patient, and he naturally believes that these are the voices of his enemies. The patient has fears, it seems to him that he will be arrested, and a voice says: “A car is coming for you, now they will knock on the door.”

We treated a patient for a long time, for whom it seemed that certain people at work were taking revenge on her for the revelation that she had made. As soon as she got ready, for example, for a walk, began to dress, a voice said: “She is going for a walk, now we will destroy her,” and no force could be used to calm her down, dissuade her, or persuade her to go out for a walk.

And with this form of schizophrenia, patients also need supportive treatment at home. This treatment is prescribed by the doctor upon discharge, and the relatives of the patients must ensure that all prescriptions are followed.

When patients stop taking their prescribed medications, this is usually a sign that their condition is worsening and should alert relatives. After recovery, patients who have suffered this form of schizophrenia also need rational employment and it is also important that at home and at work there is a normal attitude towards the patient that would support him and not traumatize him.

Family members of the patient should know that the disappearance of hallucinations is a sign of improvement in the patient’s condition, and their appearance is a symptom of deterioration that should not be underestimated. If relatives notice that the patient is hallucinating, he is listening to something, as if absent from the real situation, claims that he hears something that no one else around him hears, then it is necessary to immediately contact a psychiatrist. Apparently, the doctor will try to intensify the treatment at home, and if it does not give a noticeable effect, the patient will be admitted to a medical institution.

If only delusions appear in the picture of the disease, as happens in one of the forms of schizophrenia, then the patient’s behavior is dictated by the content of the delirium and is incorrect. During an exacerbation, incorrect behavior at home and at work is noticeable to others. Under the influence of fears, being in the grip of a painful conviction that he is being followed, being watched, eavesdropping on his every word, spying on his every step, the patient curtains the curtains, does not let anyone into his room, does not leave it himself, sits locked, etc. n. Any of these manifestations of incorrect behavior is enough to come to the conclusion that the disease has worsened and you need to immediately consult a doctor.

Counting on the fact that everything will work out somehow on its own, trying to avoid “washing dirty linen in public,” and being afraid to make public the patient’s incorrect behavior is deeply erroneous, harmful and fraught with serious consequences.

In young people, in boys, schizophrenia sometimes occurs with symptoms of foolishness, looseness, excitement, they grimace, talk a lot and incoherently, laugh absurdly, rhyme inappropriately, and hallucinate. From an everyday point of view, all this can sometimes give the impression of gaiety.

If such a condition occurs, you need to immediately consult a doctor, because it is difficult to foresee what absurd actions the patient may resort to. One young man, in a state of stupid excitement during an exacerbation of the disease, put a cat in the refrigerator, another cut up all the things in the house, inventing a costume for himself, the third made a fire at home.

One form of schizophrenia is characterized long time a continuing state of complete immobility with muscle tension throughout the body. Patients freeze in one position, sometimes uncomfortable and strange, refuse food, and stop contacting others. The patient, frozen in one position, full of tension, does not fulfill any requests, does not react to anything, does not answer when they try to talk to him. Only the expression of his eyes indicates that he sees, hears, understands, notices everything.

Indeed, having recovered, the patient can tell how those around him behaved towards him. Patients in this condition need immediate hospitalization. There is no need to try to stir up the patient, persuade him, dissuade him, because such behavior is a symptom of a serious painful condition and verbal arguments will not help. With this form of schizophrenia, agitation and aggression may suddenly occur.

The forms of schizophrenia we have described do not necessarily occur in such a pure form; different combinations of symptoms with to varying degrees their expression. It is important to know and remember what manifestations of the disease there are and what is a sign of its exacerbation.

You need to know that people who have suffered schizophrenia and successfully recovered from the painful state often remain with an altered character. In the hostel they are sometimes considered strange people, eccentrics. It is very important that in the family where such a person lives, they understand that these oddities are a consequence of the disease, and treat them tolerantly, reasonably, try not to notice them and in no case emphasize or make them the subject of jokes and ridicule.

Some signs of mental illness Caring for a patient with schizophrenia Caring for a patient suffering from manic-depressive psychosis Caring for a patient suffering from involutional (presenile) psychosis Caring for a patient suffering from psychosis of vascular origin

Nursing care in psychiatry, the role of the nurse in organizing the treatment process and the features of caring for mental patients, read about all this in our articleFeatures of caring for mental patients (

suffering from mental disorders) The role of the nurse in organizing the treatment process and the peculiarity of caring for mental patients can hardly be overestimated, since her activities include a wide range of issues, without which self-realization would be impossible therapeutic approach

to patients and, ultimately, a state of remission or recovery.
On a note!
Methods for disinfecting patient care items are established by the rules of paragraph 31 of the order of the Ministry of National Economy of the Republic of Kazakhstan dated January 27, 2015 No. 48:
– oilcloth linings, aprons, mattress covers made of polymer film, oilcloths, medical thermometers are wiped with a cloth moistened with a disinfectant solution

This is not the mechanical implementation of medical prescriptions and recommendations, but the solution of everyday issues, which include the direct implementation of treatment processes (dispensing medications, parenteral administration of drugs, carrying out a number of procedures, feeding, if there is a refusal to eat due to mental illness), carried out taking into account and knowledge of possible side effects and complications.

The Greek word “psychiatry” literally means “the science of treatment, the healing of the soul.” Over time, the meaning of this term has expanded and deepened, and currently psychiatry is the science of mental illness in in a broad sense words, including a description of the causes and mechanisms of development, as well as clinical picture, methods of treatment, prevention, maintenance and rehabilitation of mentally ill patients.

Use nonverbal (nonverbal) behavior and expression of feelings to diagnose the situation. People do not hide positive emotions, and you can tell by their facial expressions. Of course, facial expressions can be consciously controlled; they depend on national and cultural stereotypes. This creates some difficulties.

In Kazakhstan, provision psychiatric care the population and care for mental patients is provided by a number of medical institutions. Patients can receive outpatient care at psychoneurological dispensaries.

Depending on the nature of the disease and its severity, the patient is treated on an outpatient basis, in a day hospital or in a hospital. All procedures and rules of the psychoneurological hospital are aimed at improving the health of patients.

Caring for mental patients is very difficult and unique due to unsociability, lack of contact, isolation in some cases and extreme agitation and anxiety in others.

In addition, mental patients may have fear, depression, obsession and delusions. The staff is required to have endurance and patience, a gentle and at the same time vigilant attitude towards patients.

Nursing care in psychiatry

Ultimately, it is also taking responsibility for a number of activities:

1. Prepare the patient for a particular procedure or event, which sometimes requires a lot of effort, skill, knowledge of the patient’s psychology and the nature of the existing psychotic disorders from the nurse.

2. Convince the patient of the need to take the medicine. if refusal to eat in mental patients leads to complications. Go for one or another procedure, which is often difficult due to its painful products, when it is for ideological and delusional reasons of hallucinatory experiences or emotional disorders resists medical treatment.

In this case, knowledge of the clinical picture of the disease helps to correctly solve the therapeutic problem, making a positive treatment solution possible.

3. To this day, the care and supervision of mentally ill people carried out by a nurse remains relevant. This includes feeding patients, changing linen, carrying out sanitary and hygienic measures, etc. Monitoring an entire contingent of patients is especially difficult.

This applies to depressed patients, patients with catatonic symptoms, patients with acute psychotic disorders and behavioral disorders.

For a patient entering a medical institution, it is important not only the treatment, but also how he was received medical workers. In a medical institution, the patient’s first contact with medical personnel and, in particular, with a nurse is of particular fundamental importance; it is he who further determines the relationship - a feeling of trust or distrust, like or dislike, the presence or absence of partnerships. Therefore, ethics and deontology in the activities of a nurse are of particular importance.

Care and supervision are undoubtedly important links in the overall treatment plan for patients, since it is impossible to carry out therapeutic activities without these important hospital factors. Information about patients, the dynamics of their diseases, changes in the treatment process, etc. is invaluable during the complex treatment process that is carried out by mental patients in psychiatric hospitals.

Patients with dementia are radically different from other patients. Therefore, a special nursing process is required for schizophrenia. A difficult task falls on the shoulders of the medical staff, since patients often psychiatric clinics do not understand the seriousness of their illness, and some refuse to consider themselves sick.

Schizophrenia requires a special nursing process

Dementia is very dangerous disease. In most cases, the first symptoms of the disease are difficult to notice. A sick person flatly refuses to believe in his oddities and, in most cases, tries to hide them. Exist different types mental disorders, among which completely innocent actions or life threatening both the patient and those around him. But when a diagnosis has already been established, everyone would like to alleviate the condition of a loved one, for which innovative, effective techniques, as well as careful supervision. Important role plays nursing care for schizophrenia, in which all aspects of care over the patient are clearly described. Special personnel are trained for this work, and every nurse must clearly understand their responsibilities.

Behavior is an integral part of treatment medical personnel. In the hands of the sister is the life of a patient who at any moment can harm himself or others.

• Medical staff within the walls of a psychiatric clinic have to deal with people with completely different thinking and complex mental disorders. Employees must familiarize themselves with the patient’s data in detail - know the patient’s last name, first name, patronymic and the number of the room in which he is located. Treatment should be correct, affectionate and individual to each individual patient. The nurse is obliged to remember by heart what prescriptions the attending physician made for this or that patient and strictly follow them.
• Many people mistakenly believe that mentally ill people do not notice a polite attitude. On the contrary, they have a very delicate sensitivity and will not miss the slightest change in intonation and highly value good nature. But at the same time, it is worth remembering that a “golden mean” is necessary; the staff should not be too rude, nor too soft, ingratiating. It is strictly forbidden to single out among patients those who would like to be given preference more often in help, care, and then immediately neglect others.
• It is important to maintain a normal environment within the clinic; everyone should know their responsibilities. Loud talking, shouting, and knocking are not allowed, since the main condition in psychiatric clinics for the peace of mind of patients is peace and quiet.
• Female staff should not wear shiny items: jewelry, earrings, beads, rings, as patients can tear them off. This is especially true for departments where patients with serious forms of the disease are treated.
• If there is a sudden change in the patient’s condition or changes in his speech, the nurse must immediately notify the attending or duty doctor about this.

Medical staff have to deal with people with completely different mental disorders

• You cannot have conversations with colleagues in the presence of patients, especially discussing the condition of other patients. It is unacceptable to laugh or treat wards with even the slightest degree of irony or jokes.
• In most psychiatric clinics, at the moment acute phase Visits are prohibited due to illness. Therefore, relatives pass notes and letters to their loved ones, which should be read before handing them over. If they contain information that could aggravate the patient’s condition, transmission is prohibited, and a conversation with relatives will be required. When transferring things or products, you must carefully inspect each package: there should be no sharp, cutting, piercing objects, matches, alcohol, pens, or medications.

• The duties of the nurse include supervising the orderlies. She must clearly set tasks to complete and monitor their implementation. Constant supervision in such establishments - important condition. Thus, patients will not be able to injure themselves or their companions, commit suicide, escape, etc. Patients in psychiatric clinics should not be left alone for a minute and should not be out of sight of the staff. If the patient is covered with a blanket, you need to go up and uncover his face.
• Temperature taking and medication administration must also be strictly supervised. For suicide purposes, the patient may injure himself with a thermometer or swallow a thermometer. Do not turn away or leave the room until the patient drinks them in front of the nurse.

The medication must be taken under the strict supervision of medical staff.

Maintenance of wards in clinics

Often, with complex forms of the disease, patients cannot eat, make their bed, go to the toilet, or wash themselves. Requires light, liquid food that does not cause injury, painful sensations when swallowing. When feeding through a tube, you must rinse your mouth after each meal.

The bed should always be clean, the patient needs to regularly place a bedpan, if necessary, use an enema, required water procedures after each act of defecation and urination. In a catatonic state, urinary retention is possible, so special catheters are used.

Important: the nurse must examine the patient’s body and skin twice a day to make sure there are no bedsores, diaper rash, redness, swelling, or rash.

How to deal with schizophrenia

The answer to this question has been sought for centuries. Medicine, which would allow us to get rid of it forever mental illness, have not yet been invented. But there are still achievements, thanks to which stable remission is maintained and two thirds of total number sufferers lead a normal life. The fight against schizophrenia includes a set of measures that must be strictly followed.

1. Taking medications that stop, stabilize, and maintain remission in the patient.
2. Regular visits to the attending physician, undergoing various types of procedures.
3. Harmonious relationships should be maintained in the house; the patient should not be subject to attacks due to quarrels, scandals, loud parties, conversations, etc.

People with schizophrenia should definitely visit a psychiatrist

An important point in the treatment of mental disorders is to contact only official specialized institutions. The specialist must have a certificate of compliance with the standards of the Ministry of Health, accreditation, and qualification documents. It is best if relatives collect information through forums, where reviews of leading doctors in psychiatric clinics are always reflected.