Ticket 1

1 , . . , . . , . .
1. Differentiation of obsessions, overvalued ideas and delusions.-disorders of thoughts!! , .
Delusion - false belief of great value to a patient, cannot be corrected by reasoning Persecutory delusions gap.dc Acute delusion Depressive delusions Grandiose delusions Chronic delusion: I. paranoia (primary systemized idea of persecutions, jealousy without hallucination II. paranoid (hallucination and delusional states with persecutory ideas) III. paraphrenia (hallucination and delusional states with bizarre ideas) Overvalued ideas - sustained ideas of great personal values which is no absolutely false but inadequately significant Obsessions - pathological persistence of an irresistible thought or feeling that cannot be eliminated. Rumination (irrational burdensome operating with thought, symbols, words or numbers) Contrast ideas (irrational painful thought about possibility of dangerous or antisocial actions)

2. Alcoholic psychoses. Clinic subtypes. Treatment.Prevention of delirium tremens in somatic patients.., .

Clinical symptoms: -changes in tolerance, marked personality changes (loss of will, disregard of duty and norms behavior, moral degradation)<withdrawal symptoms..deliriumcomes first then nialcohol psychoses> 3 stages: true hallucination,illusion,excitement/agitated like Delirium tremens -acute psychosis induced by severe alcohol withdrawal syndrome (illusion, true hallucinations) *Treatment: sedative (benzodiazepines, barbiturates), treatment of withdrawal syndromes-fluids, diuretics, nootrops, vitamins, adequate nutrition Alcohol hallucinosis - acute psychosis induced by severe alcohol withdrawal syndromes (abundance true hallucinations) *Treatment: antipsychotics, benzodiazepines Delusional alcohol psychosis - encephalopathy induced by severed alcohol delirium (amnestic syndromes with peripheral neruropathy) *Treatment: antipsychotics, benzodiazepines Korsakov psychosis - encephalopathy induced by severe alcohol delirium *Treatment: vitamin B1, nootrops Gayet-wernicke encephalopathy - acute alcohol encephalopathy (ataxia, vestibular dysfunction, ocular motility abnormalities disorder of consciousness) *Treatment: thiamin, treat cerebral oedema(diuretics, corticosteroid hormones, anticoagulant)

3. The law On psychiatric health care", its main sections. The organizational forms of psychiatric health care.Therightsofthementallyill. , .
Those, who suffer mental disorders, possess all rights and freedoms of citiz ens, provided by constitution RF.

1. 2. 3.

The person, who suffers mental disorder, can be hospitalized into the psychiatric hospital without its agreement to the decision of judge, if his inspection or treatment are possible only under the stationary conditions, and mental disorder is heavy and specifies: its direct danger for itself or surrounding; its helplessness (i.e., the incapacity to independently satisfy basic vital needs); essential harm to its health as a result of worsening in the mental conditio n, if face will be left without the psychiatric aid. Rights of patients, who are found in the psychiatric hospital: - to be turned directly to the head physician or the head. by department on questions of treatment, inspection, extraction; - to give without the censorship of complaint into any organs; - to be met with the attorney and the clergyman in private; - to practice religious rites; - to extract newspapers and periodicals; - to obtain formation, if patient did not reach 18 years; - to obtain reward for the labor, if patient participates in the productive labor. The rights of the patients, who can be limited in the interests of their health or in the interests of health and safety of the others: - to conduct correspondence without the censorship; - to obtain and to send messages, wrappers, money orders; - to use telephone; - to assume visitors; - to have necessities , to use its own clothing.

Ticket 2

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1. Korsakoff syndrome.
Syndromes: between memory) failure of registration (minute memory) anterograde and retrograde amnesia amnestic disorientation (time and place but not personality) paramnesia (confabulation (imagined or untrue experiences) which cover the gaps

Diagnostic: Whenever someone has a possible diagnosis of alcoholism, and then has the sudden onset of memory difficulties, it is important to seriously consider the diagnosis of Korsakoff's syndrome. Although the patient's ability to confabulate answers may be convincing, checking the patient's retention of factual information (asking, for example, for the name of the current president of the United States), along with the patient's ability to learn new information (repeating a series of numbers, or recalling the names of three objects ten minutes after having been asked to memorize them) should point to the diagnosis.

2. Recurrent schizophrenia (schizoaffective disorder). Subtypes.Treatment. Progression with acute attacts (Schub)
Def : acute psychosis with bright affect (mania, depression, fear) with specific symptom of schizophrenia (delusion ,paranoia and hallucination) The separate assaults, which are continued from 2-3 weeks to several months, Remissions, with complete (practically temporary recovery) or incomplete (with the signs of schizophrenic defect or the residual symptoms of the past assault), Duration of remissions - from 1-2 weeks to many years. Acute polymorphous syndrome - are developed several days, it lasts week. Special features: The flow by the acute assaults

 1.

2. 3. 4.

Subtypes: acute delirious paranoid schizophrenia- (acute paranoiac(he thinks sumone is following him), acute paranoid(someone following u,illusion n hallucination), acute paraphrenic(avatar..pt thinks hes gone into a diff space), acute hallucinosis, the acute syndrome of mental automatism) acute affective simple schizophrenia-(depressive syndrome or maniacal syndrome), acute affective- delirious-hebephrenic (disorganized type)- (combination of depressive or maniacal syndrome with one of the hallucinatory-delirious syndromes) acute catatonic catatonic schizophrenia- (catatonia - catatonic stupor or excitation). Treatment: anti-psychotic, antidepressive, tranquilizing and stimulating action.

3. Medical deontology, medical ethics. Significance for the clinic.

Main direction of the professional activity of psychiatrist is the rendering of psychiatric aid any to that being needing it, and also assistance to strengthening the mental health of population. Basic condition of the code: the professional competence of doctor- psychiatrist - his special knowledge and skill of doctoring is the necessary condition of psychiatric activity; psychiatrist is not right to disrupt the ancient ethical commandment of the doctor: First of all not to harm "; any abuse by psychiat rist by its knowledge and by the position of doctor is incompatible with the professional ethics; the moral responsibility of psychiatrist - to respect freedom and independence of the personality of patient, his honor and merit, to worry about the observance of his rights and of legitimate interests; psychiatrist is not right to reveal without the permission of patient or his lawful representative of information, obtained in the course of inspection and of treating the patient and the components medical secret; with conducting of scientific studies or of testing of new medical methods and means with the participation of patients the boundaries of permissibility and condition for their conducting must be previously determined; moral right and the debt of psychiatrist - to defend its professional independence; in the interrelations with the associates as main ethical bases serve the honesty, validity, decency, respect for their knowledge and experience, and also readiness to pass on their professional knowledge and experience.

Ticket 3

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1.Asthenia due to a general medical condition. Descriptive features. Treatment. - Weakness , lethargy caused by diseases. Treatment: protein, vitamins, anything that gives energy 2. Recurrent schizophrenia (schizoaffective disorder). Subtypes.Treatment. Progression with acute attacts (Schub)
1. 2. 3. 4. The separate assaults, which are continued from 2-3 weeks to several months, Remissions, with complete (practically temporary recovery) or incomplete (with the signs of schizophrenic defect or the residual symptoms of the past assault), Duration of remissions - from 1-2 weeks to many years. Acute polymorphous syndrome - are developed several days, it lasts week. Special features: The flow by the acute assaults Nature of the assault: acute delirious paranoid schizophrenia- (acute paranoiac, acute paranoid, acute paraphrenic, acute hallucinosis, the acute syndrome of mental automatism) acute affective simple schizophrenia-(depressive syndrome or maniacal syndrome), acute affective- delirious-hebephrenic (disorganized type)- (combination of depressive or maniacal syndrome with one of the hallucinatory-delirious syndromes) acute catatonic catatonic schizophrenia- (catatonia - catatonic stupor or excitation). Treatment: anti-psychotic, antidepressive, tranquilizing and stimulating action.

3. Medical deontology, medical ethics. Significance for the clinic.

Main direction of the professional activity of psychiatrist is the rendering of psychiatric aid any to that being needing it, and also assistance to strengthening the mental health of population. Basic condition of the code: the professional competence of doctor- psychiatrist - his special knowledge and skill of doctoring is the necessary condition of psychiatric activity; psychiatrist is not right to disrupt the ancient ethical commandment of the doctor: First of all not to harm "; any abuse by psychiat rist by its knowledge and by the position of doctor is incompatible with the professional ethics; the moral responsibility of psychiatrist - to respect freedom and independence of the personality of patient, his honor and merit, to worry about the observance of his rights and of legitimate interests; psychiatrist is not right to reveal without the permission of patient or his lawful representative of information, obtained in the course of inspection and of treating the patient and the components medical secret; with conducting of scientific studies or of testing of new medical methods and means with the participation of patients the boundaries of permissibility and condition for their conducting must be previously determined; moral right and the debt of psychiatrist - to defend its professional independence; in the interrelations with the associates as main ethical bases serve the honesty, validity, decency, respect for their knowledge and experience, and also readiness to pass on their professional knowledge and experience.

Ticket 4

4 1. . . . 2. . , . . 3. (). . . .
1. The syndrome of Psychic automatism (Kandinsky-Clearambeaur complex). Descriptive features.
Pseudohalusination Mental automatism : alienation of thought, perception n emotion, movement Delusion of control (of distant influence)

2. The substance-related disorders. Subtypes.Risk factors.

disorders of intoxication, dependence, abuse, and substance withdrawal caused by various substances, both legal and illegal. These substances include: alcohol, amphetamines , caffeine, inhalants, nicotine, prescription medications that may be abused (such as sedatives), opioids (morphine, heroin), marijuana (cannabis), cocaine, hallucinogens, and phencyclidine (PCP).

Subtypes: alcohol-related disorders amphetamine-related disorders caffeine-related disorders cocaine-related disorders hallucinogen-related disorders inhalant-related disorders nicotine-related disorders opioid-related disorders sedative-, hypnotic-, or anxiolytic-related disorders Risk Factors
Neuroinfections: Encephalitis - acute psychosis with the loss of consciousness according to the type of the exogenous type of reactions, affective, delirious manifestations, psycho-organic and Korsakoff's syndromes. Forms delirious, amential- delirious, maniacal.

Meningitis - asthenia in prodrome (An early symptom indicating the onset of an attack or a disease ), at the peak of disease - the loss of consciousness. Serous meningitis - with epidemic parotitis - sleepiness, apathy, psycho-sensory disorders. Delirium, hallucination Intoxication + clouding of consciousness, organic stupor and coma

3. Neuroleptics (antipsychotics). Subtypes, side effects.

a) PHENATHYAZINE Chlorpromazine Trifluoperazine Thioridazine b) BUTIROPHENONE Haloperidol Trifluperidol c) THIOXANTHINE Chlorprothixene Flupentixol d) BENZAMIDE Sulpiride Tiapride Side effects Parkinsonism Acute dystonia Akathisia (restlessness) Dryness of mouth (somatic adverse effects) Tachycardia Neuroleptic malignant syndrome (fever,sweating,increasedcreatinin phosphokinase and myoglobinuria)

Ticket 5

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1. Symptoms and syndromes of disorders of memory.
Syndromes Korsakov: failure of registration (minute memory) anterograde and retrograde amnesia amnestic disorientation (time and place but not personality) paramnesia (confabulation (imagined or untrue experiences) which cover the gaps between memory)

Symptoms: - Hypermnesia: exaggerated degree of retention and recall, increased memory!! - Hypomnesia: difficulties of registration, retention and recall of memories - Failure of registration: minute memory - Amnesia: gap, loss of memories but not the ability to register Organic amnesia- retrograde amnesia, anterograde amnesia, progressive amnesia Psychogenic amnesia (eg: hysteric) - Paramnesia Allomnesia: filling of gaps in memory by real experiences but of other time Confabulation: imagined untrue experiences between memory gaps

2. Malignant schizophrenia (Kraepelins subtypes). Descriptive features. Treatment.

It appears predominantly at the childre n's and youthful age (malignant youthful schizophrenia, early dementia in the narrow sense). The initial symptomatology of malignant schizophrenia consists of a gradual drop in the mental productivity, emotional changes and features of the distorted pubertal crisis, entire system of mental activity changes.

Further development of personality stops, lose previous interests, , tendency toward the contact disappears. Sharply changes the behavior of patient in the family. Sluggish, passive out of the house, patients become cold, rough, hostile to the close ones.(antisocial,apathy)

3. Psychotherapy. Methods.Indications and contraindications.

Method of working with patients to assist them to modify, change or reduce factors/disorders that interfere with effective living. Methods: counseling!! Individual Couples Family Group

Ticket 6

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1. Paranoid disorder. Descriptive features.

Paranoia: chronic delusion, primary systemized ideas of persecution, jealousy on invention without hallucination, fear heading towards delusion.

2. Hysterical neurosis (Dissociative Disorders). Descriptive features. Place in ICD-10. Treatment.

I. II. III. F44 in ICD-10 Characterized by physical or psychological symptoms for which no physical cause can be identified but which are linked to meaningful physiological stressors Symptoms : Neurological (loss or change in sensory or motor function, blindness,seizures) Somatic (headache, stomachache, painful extremities, diff swallowing, dysmenorrhea) Psychological (amnesia, false visions, fears, crying/laughing, substance abuse)

* treatment: refer to question below 3. Side effects of neuroleptics (antipsychotics), tranquilizers, antidepressants. Treatment and prevention
Neuroleptics Parkinsonism, akathasia and acute dystonia *Treatment :anticholinergics (biperiden-akineton, trihexiphenidil-parkopan) antihistamine (diphenylhidramine) Neuroleptic malignant syndrome *Treatment : symptomatic (antipsychotic, cooling, monitoring vital signs ) Tranquilizers Drowziness, muscular relaxation, stoppage of breathing Antidepressants Anticholinergic effects (urine retention, tachycardia, heart failure, constipation, visual impairment, mydriasis)

Ticket 7

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1. Epileptic reaction, epileptic syndrome, epileptic disease. Concepts, diagnostic and prognostic significance, approaches to therapy.
Etiology : endogenous Course : Chronic progressive Symptoms and syndromes Productive symptoms : different but never paroximal Negative symptoms : selfishness, stiffness, emotional rigidity Syndrome : Idiopathic or symptomatic of underlying brain damage or disease seizure syndromes in newborns; febrile convulsions; West syndrome (infantile spasms); Lennox-Gastaut syndrome; childhood absence epilepsy; juvenile myoclonic epilepsy; Rolandic epilepsy; Landau-Kleffner syndrome; Rasmussens encephalitis (syndrome); progressive myoclonic epilepsy; temporal lobe epilepsy, and frontal lobe epilepsy Diagnosis : Laboratory, EEG, MRI, CT Treatment : Seizures (valproate, carbamazepine) Petit mal (valproate, clorazepate) Grand mal (phenobarbital, gabapentin) Focal seizures : carbamazepine

2. Slowly progressive schizophrenia (schizotypal disorder). Clinical features. Treatment.

Schizotypal disorder : characterized by a need for social isolation, odd behavior and thinking and often unconventional belief A pervasive pattern of social and interpersonal deficits marked by acute discomfort with and reduced capacity for, closed relationships as well by cognitive and perceptional distortions, beginning at early adulthood. (antisocial, unconventional belief!) Treatment : antidepressant, anti anxiety, antipsychotic Psychotherapy, behavioural therapy, cognitive therapy

3. Sociotherapy and rehabilitation in psychiatry. Psychoeducation.

Psychosocial Rehabilitation Psychiatric (symptom management); Social (relationships, family, boundaries, communications & community integration); Vocational and or Educational (coping skills, motivation); Basic Living Skills (hygiene, meals, safety, planning, chores); Financial (budgets); Community and or Legal (resources); Health and or Medical (maintain consistency of care); Housing (safe environments). Rehabilitation process of restoration of community functioning and wellbeing of an individual who has a psychiatric disability (been diagnosed with a mental disorder). Rehabilitation work undertaken by psychiatrists, social workers and other mental health professionals (psychologists and social workers, for example) seeks to effect changes in a person's environment and in a person's ability to deal with their environment, so as to factiliate improvement in symptoms or personal distress Psychoeducation

education offered to people who live with a psychological disturbance. Frequently psychoeducational training involves patients with schizophrenia, clinical depression, anxiety disorders, psychotic illnesses, eating disorders, and personality disorders, as well as patient training courses in the context of the treatment of physical illnesses. Family members are also included. A goal is for the patient to understand and be better able to deal with the presented illness

Ticket 8

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1. Illusions and hallucinations. Definitions.Diagnostic value.
Illusion- misperception or misinterpretation of real external sensory stimuli Hallucination- false memory perception or mental impressions of sensory vividness not associated with real stimuli.

2. Functional mental disorders of elderly age. Subtypes, clinical features, treatment Alzhemers, dementia, delirium, paranoia, depression, anxiety, Picks disease ( progressive dementia) 3. Mental disorders (syndromes and diseases), common in general practice.
Transitory psychosis (loss of consciousness) - Delirium - acute psychosis with illusions and true hallucination, excitement, disorientation in time, place and situation. - Amentia - deep disorder of consciousness with incoherence - Oneiroid state - dream like state with dual orientation, develops basis on fantasy illusion, - Twilight state - action maybe performed without conscious coalition and without any remembrance afterward Korsakov; amnesia ( loss of memory but not the ability to remember), paramnesia (allomnesia- filling gaps with true real experiences but during other time period; confabulation-imagined untrue experiences between memory gaps ) psycho-organic (disorder of attention, memory and intellectual activity, emotional disorder classify as: degenerative cerebral diseases, cerebral arteriosclerosis, tumours, trauma, and infections.).

Ticket 9

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1. Maniac disorders. Descriptive features, diagnostic value.
Maniacal triad: hyperthymia (elevated glad mood), the acceleration of associative processes (from a certain lightening to the gallop of ideas), motion excitation. Distractedness; patients cannot bring the matter to the end initiated. A sense of self-respect (self overating, mood-congruent delusion, ideas of randuer) is increased; patients are convinced that the large discoveries await them, that they can play role in the solution of serious social problems. In patients vocal excitation is observed (pressure to talk), they speak much, it is rapid, loudly, Patients characteristic: they are animated, face is frequently hyperemized, mimicry living, motion rapid, appetite is increased, and sexual inclination is intensified, insomnia( sleeps shortly but without tiredness), healthy (no somatic complaint)

They separate several versions of the maniacal syndrome: jovial mania, unproductive mania, mania with foolishness, [morii] (frontal symptomatology), hypomania. Treatment: Maniacal states - neuroleptics and mood stabilizer (lithium salt, Carbamazepin)

2. Obsessive-compulsive disorder. Descriptive features. Subtypes in ICD-10. Treatment.

mental disorder characterized by intrusive thoughts that produce anxiety, by repetitive behaviors aimed at reducing anxiety, or by combinations of such thoughts (obsessions) and behaviors (compulsions). The symptoms of this anxiety disorder range from repetitive hand-washing and extensivehoarding to preoccupation with sexual, religious, or aggressive impulses. ICD-10 :F60.5 Anankastic (OCD) Treatment 1. Psychotherapy 2. SSRI : Paroxetine, Sertraline, Fluoxetine, Escitalopram 3. Tricyclic Antidepressant : Clomipramine

3. Antidepressants. Subtypes, side effects, application in common practice.

Antidepressants: to treat depressed mood usually by increasing the activity of monoamine receptors. The effect develops slowly (2-3 weeks) Clinical classification: - Inhibitors of monoamine reuptake- nonselective (tricyclic and heterocyclic drugs- imipiramine, amitriptyline, clomipramine), serotonin specific reuptake inhibitors - Monoamine oxidase inhibitors- nonselective nonreversible (phenelzine), selective reversible (monocyclic, befol) - Other mianserine, milnazipran, tianeptine Side effect: (short term) - Sedative amitryline - Harmonizing meprotilin - Stimulating imipramine Side effect tricyclic: retention of urine, tachycardia, heart failure, postural hypotension, constipation, difficulties in visual accommodation, mydriasis, possibilities of glaucoma, sexual dysfunction

Ticket 10

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1. Senestopatii. The concept.Differentiation of pathological sensations (senestopaties) and real somatic sensations.
Sensation - such form of mental activity, which reflects only to the separate properties of phenomena and objects, which influence the sensory organs . Perception - the integral reflection of those phenomena or objects, which act on our sensory organs. Recognition and interpretation of sensory stimuli based chiefly on memory. Cenesthopathy: unfounded strange inexplicable sensations in bodily organs Parasthesias: An altered sensation reported by the patient in an area where the sensory nerve has been afflicted by a disease or an injury (is a sensation of tingling, pricking, or numbness of a person's skin with no apparent long-term physical effect) Quantitative disorders of the sensation: a. Anesthesia - the disorders of a feeling of pain, which are characterized by loss or decrease of the painful sensitivity b. Hypaesthesia - reduction in the sensitivity to the external stimuli. (everything under the mute). c. Hyperaesthesia - is a condition that involves an abnormal increase in sensitivity to stimuli of the senses

d. e.

Cenesthesia - the special feature of the sensory reception, which is consisted in the fact that the external stimulus, addressed to one analyzer, causes simultaneously answer from some another or several analyzers. Hysterical anaesthesia- lost of sensory modalities due to emotional conflicts.

Quantitave disorders of the perception: a. Illusions misperception or misinterpretation of real external sensory stimuli b. Hallucination false sensory perceptions or mental impressions of sensory of vividness not associated with real external stimuli. c. Derealization a subjective sense that the environment is strange or unreal d. Depersonalization a subjective sense of being unreal, strange or unfamiliar to oneself

2. Clinical subtypes of personality disorders.

Psychopathy - anomaly of the development of personality. Most often inheriditary. Psychopaths:- individual which provoke interpersonal conflict make other people to suffer a lot. psychopathies can arise on any temperament (characters), except sanguine (cheerful) a. b. c. 1st group: they are more frequent against the background the choleric (irritable) character. 2nd group: developed on the phlegmatic (apathetic- Feeling or showing a lack of interest or emotion) character. 3rd group: developed on the melancholy (gloomy- Tending to cause sadness or low spirits, sadness, depressing) temperament

3. Traditional classification of mental disorders. Features of ICD-10. Pg 33..F0-F10 Ticket 11

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1. Depression. Descriptive features. Subtypes.
Depressive syndrome - lowered, depressed mood, intellectual and motor retardation It is not only characterize by mental suffering, but also is accompanied by the physical painful sensations (vital melancholy): by discomfort in the epigastral region, by gravity or by pains in the region of heart. Depressive syndrome is characterized by the depressive triad: 1. hypothymia (depressed mood, melancholy, melancholy, anxiety, apathy) 2. retarding thinking (depletion of thinking, few thoughts, they they flow slowly, they are riveted to the unpleasant events) 3. motional retardation (slowing of movement and speech). Depression with anxiety up to agitation depression associated with severe anxiety, excitement and motor restlessness, more common for patient of involution age. High suicidal risk Masked depression manifested by somatic symptoms (heartache, headache, stomachache, hypertension)

2. Dementia of the Alzheimer's Type. Psychotic disorders of elderly age.

Degeneration of the brain cells. It is different from normal senility in the elderly in that the patient's brain function will gradually deteriorate resulting in progressive loss of memory and mental abilities, and noticeable perso nality changes memory impairment (impaired ability to learn new information or to recall previously learned information) one (or more) of the following cognitive disturbances: aphasia (language disturbance) apraxia (impaired ability to carry out motor activities despite intact motor function) agnosia (failure to recognize or identify objects despite intact sensory function) disturbance in executive functioning (i.e., planning, organizing, sequencing, abstracting) The course is characterized by gradual onset and continuing cognitive decline Treatment:

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Ach-esterase inhibitor (donepezil, galantamine) Excitatory neurotransmitter (memantine) Antipsychotic Psychotherapy

3. Phytotherapy of mental disorders.

Treatment by the preparations, obtained from the vegetable raw material. During emotional lability, the periods of irritability, tearfulness, anxiety, asthenia, phenomena of hyperesthesia-> sedative properties valerians, motherwort, pion, passiflora, balm. During apathy, the lung reduction in the initiative, the zsthenia-depressive disorders -> preparations from the ginseng, aralia, tea-plant, eleuterococcus, schisandra, gold root. Factors Influencing To Prefer Herbal Therapy - Patient request/pressure - In general practice - Lack of effective conventional treatment - Belief in safety and/or efficacy - Attempt to improve physician-patient relationship - Profitability - Training in or familiarity with a herbal therapy - The alternative therapy fit the patients cultural beliefs - The patient failed to respond to conventional treatment The patient had a non-organic disease

Ticket 12

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1. Asthenia. Differentiation of asthenia due to a general medical condition and asthenia due to stress.
Asthenia - can be the only manifestation of a psychic illness - increased fatigue (from the morning itself), the difficulty of the concentration of attention, retarding perception, emotional lability, increased vulnerability, rapid distractedness. Hyperesthesia is characteristic

2. Manic-depressive psychosis (Bipolar Disorder). Cyclothymia.Treatment.

Cyclothymia - A mild affective disorder characterized by alternating periods of elevated and depressed mood. - a persistent instability of mood, involving numerous periods of mild depression and mild elevation. - This instability usually develops earlu in adult life and pursues a chronic course, although at tiems the mood may normal and stable for months at times - The mood swing are usually perceived by the individuals as being unrelated to life events - Depressive stage, maniacal stage and mixed states.

3. Alcohol abuse. Stages of Alcohol Dependence.Treatment and rehabilitation.

Stage I I. II. III. IV. Stage II I. II. III. IV. Stage III Physiological dependence Loss of dose control Increase tolerance Amnestic intoxication (blackouts) (cant puke no matter how much u drink as reflex is gone) Psychological and physiological dependence (abstinent syndrome, alcohol withdrawal syndrome) Alcohol psychoses Personality changes Highest tolerance

11

I. II. III.

Reduced tolerance Irreversible changes in internal organs (cirrhosis, cardiomyopathy, neuropathy) Dementia or Korsakovs (creates his own memory) syndrome

Ticket 13

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1. Masked depression (depression with a predominance of somatic symptoms). Descriptive features. Principles of treatment.
Masked depression manifested by somatic symptoms (heartache, headache, stomachache, hypertension) Diagnose: dexamethasone-supression test (if the concentration of drug is above 5mg meaning pt has masked depression..if the concentration is low the morning after the patient is normal)

Masked depression often manifests itself as headaches, stomach pain, a nagging ache in the lower back and pain in the jaw. The root of the problem is psychological and should be treated with antidepressants

2. Personality disorders (psychopathies). Diagnostic features.Differential diagnosis of personality disorders, personality changes due to a general medical condition andpersonality changes due to schizophrenia.
Complex of endogenous, biological, physiological and social factors Functional structure deterioration ICD 10: severe disturbance in the characterological constitution and behavioural tendencies of the individual involving severe areas of personality and associated with considerable personal and social disruption. F 20 * 0 (continuous progression) F 20 * 1 (progression with acute attacks) F 20* 3 (periodic or recurrent) F 21 (special type with sluggish or slow progression) Diagnosis Marked disharmonious attitude and behavior (affectivity, arousal, impulse control) Abnormal behavior pattern Appear during childhood and adolescence Dysadaptation Personal distress Personal changes General medical conditions Mental weakness, increase fatigue Disorder of attention, memory and intellectual Psychosis Schizophrenia Introversion, low interest Indifferent to either praise or critism Strange mixture of emotional coldness Marked sensitivity Progressive

3. Outpatient psychiatric service. Dispensary observation, ethical issues.

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Consultative-therapeutic aid: - by doctor- psychiatrist (with patient agreement and without the patients agreement in case of danger for the patients or their surrounding due to their illness) Clinic observation Tasks of psychoneurological dispensaries and psychiatric offices: - Consultative, diagnostic, therapeutic, psycho prophylactic rehabilitative aid under the extra hospital conditions; all forms of the psychiatric examination of forensic, military, temporary disablement; social-welfare aid and assistance in job placement of those, who suffer mental disorders; resolve questions about guardianship; consultation on lawful questions and other forms of juridical aid.

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1. Differentiation of true hallucinations and pseudohallucinations.
True hallucination: - bright vivid perception, natural way of perception, confidence with the fact that other people have it (perception) too Pseudohallucination:- lack of vividness, other perception( internal vision of hearing), perceptions only for the patients himself.

2. Mental disorders due to syphilis and progressive paralysis. Clinical features, course, treatment.
Syphillis (exogenous) syphilitic psychosis General paralysis of insane (GPI) appears in some patient in 10-15 years after infection Symptoms of encephalitis 1. Euphoria 2. Dementia 3. Severe personality changes Neurological signs 1. Pupil not constrict 2. Asymmetrical tendon reflex Treatment : antibiotic, iodotherapy, bismuth drugs Endogenous (progressive paralysis) Alzheimers and Picks Disease Spontaneous onset Autochronous course Chronic progressive Asthenia (increase fatigue, difficulty of concentration, retarding perception) Neuroses-like disturbances Delirious state

3. The course and outcome of mental illness. Clinical, diagnostic and prognostic significance of these characteristics.
1. 2. 3.

Course and prognosis : Process : acute, chronic with progressive/regress, recurrent, indulating Stable defect Pathogenic development Outcome : recovery, death, personality changes, stable defect

Ticket 15

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1. Disorders of will, desire, attention. Attention Deficit Hyperactivity Disorder.
Disorders will: - Hyperbulia - Hypobulia - Abulia Parabulia

- reinforcement, intensification of drives - weakening of drives - the loss of will and energy, laziness, reduced impulse to act and think, often associated with emotional indifference (apathy) - Abnormality of volition or will, as when one impulse is checked and replaced by another. (disorder of behavior and impulse control)

Disorders of the inclinations a. Disturbance of inclinations to the food: - Bulimia - pathologic, sharply intensive feeling of hunger, which is frequently accompanied by general weakness and abdominal pains followed by feelings of guilt, depression, and self condemnation. - Anorexia - loss of a feeling of hunger, the absence of appetite with the presence of the physiological need for the nourishment. - Polydipsia - Excessive or abnormal thirst. - parorexia - Abnormal or inappropriate appetite, especially a craving for items unsuitable as food; pica ( persistent craving and compulsive eating of non-food substances). - coprophagy, scatophagy Disturbance of the instinct of the self-preservation: - Weakening the reflex of self-preservation. - Strengthening the reflex of self-preservation. Disturbances of the sexual inclination: onanism( happily masturbates without caring about surrounding),promiscuity (sex between many partners), group sex, hyper sexuality, erotomania entire life in the sex, impotence,vaginism, homo and transsexual, pedophilia, incest.

b.

c.

Disorder of attention. Attention occurs active and passive Distractedness, (with the depression), exhaustion (with the organic diseases and the aesthetic states)

2. Neurotic disorders. Definition.Subtypes.Treatment.

Concept: - Any of various mental or emotional disorders, such as hypochondria or neurasthenia, arising from no apparent organic lesion or change and involving symptoms such as insecurity, anxiety, depression, and irrational fears, but without psychotic symptoms such as delusions or hallucinations. - Spectrum of illness appeared with mild mental or somatic symptoms, which production is unconscious and originated from unconscious motives and conflicts. Type: intellectual, artistic Clinical forms: - Neurasthenia: appears symptoms of asthenia (fatigability with irritability) that are linked to meaningful psychological stressor - Hysteria: physical or physiological symptoms for which no physical cause can be identified but which are linked to meaningful psychological stressors. - Obsessive-phobic neurosis: a spectrum of illness appeared with the symptoms of anxiety, unreasonable fears, obsession and ritual, associated with internal conflict.

3. Age crises and their significance for clinical psychiatry. Disorders usually first diagnosed in childhood, adolescence and elderly age.

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They begin from 45-60 years Psychoses of the senile age - after 60-65 years Senile dementia (senile dementia) - are developed into 65-85 years

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16 1. . , , . 2. . , , . 3. (, ). . .
1. Overvalued ideas. Descriptive features.
Concept: sustained ideas of great personal value, which are not absolutely false but inadequately significant un such way that it disturbs the adaptation of individual. Clinical: true ideas, poor insight, poor behavior control but possible, diagnosis subpsychotic states (initial period of psychoses), paranoid personality.

2. Alcohol withdrawal delirium. Precursors,clinical features, treatment.

A disorder characterized by the excessive consumption of and dependence on alcoholic beverages, leading to physical and psychological harm and impaired social and vocational functioning. Classification by E.M Jellinek Alpha, beta, gamma, delta, epsilon alcoholism Russian: stage 1- only psychological dependences Stage 2- psychological and physiological dependence Stage 3- reduced tolerance Alcohol withdrawal syndromes - Symptoms: desire for alcohol, affective instability (dysphoria, depression, anxiety), neurologic symptoms (nystagmus, tremor, atxia), malaise, sleep disorder, arterial hypertension, tachycardia - Treatmnent: detoxication fluids by mouth or intravein, diuretics, vitamins, nootrops. Alcohol psychoses a. Delirium tremens

acute psychosis induced by severe alcohol withdrawal syndrome (illusion, true hallucinations) - Treatment: sedative (benzodiazepines, barbiturates), treatment of withdrawal syndromes-fluids, diuretics, nootrops, vitamins, adequate nutrition

b.

alcohol hallucinosis - acute psychosis induced by severe alcohol withdrawal syndromes (abundance true hallucinations) - treatment: antipsychotics, benzodiazepines Delusional alcohol psychosis - encephalopathy induced by severed alcohol delirium (amnestic syndromes with peripheral neruropathy) - treatment: vitamin B1, nootrops Gayet-wernicke encephalopathy - acute alcohol encephalopathy (ataxia, vestibular dysfunction, ocular motility abnormalities disorder of consciousness) - treatment: thiamin, treat cerebral oedema(diuretics, corticosteroid hormones, anticoagulant)

c.

d.

e. karsakov (filling in the gaps with previous past memories) 3. Differentiation of psychotic and non-psychotic disorders. Positive symptoms and negative symptoms.
Psychotic: psychogenous, the result of acute irresistible stressors concerning the primary personal needs (safety, health, honour, freedom. Functional structure deterioration.

15

Serious mental derangement characterized by defective or lost contact with reality. The primary psychoses are schizophrenia and the delusional disorders (e.g., megalomania), but extreme cases of depression and bipolar disorder, substance-induced delirium, and certain varieties of dementia are also understood to share important features with the psychoses. The major symptoms, aside from delusions and hallucinations, are disorganized speech and behaviour and, often, mood disturbances * severe mental disorders, construct false environment, poor insight, cant tell their ill Productive symptoms: rather prominent (psychotic level) often with dangerous (or suicidal) behavior - severe mental disorders - construct a false environment (hallucinations, delusion) - dangerous behaviors (aggression, suicide, excitement) - poor insight (no sense of illness) Negative symptoms: no Any of various mental or emotional disorders, such as hypochondria or neurasthenia, arising from no apparent organic lesion or change and involving symptoms such as insecurity, anxiety, depression, and irrational fears, but without psychotic symptoms such as delusions or hallucinations. - Spectrum of illness appeared with mild mental or somatic symptoms, which production is unconscious and originated from unconscious motives and conflicts. *mild mental, can tell real environment, isnt assume rash/dangerous/antisocial actions, realize their mentally ill Productive symptoms: - rather different but ever mild - mild mental disorders - apprehend the real environment and situation without significant mistakes - do not assume rush, dangerous or antisocial actions - realize that they are mentally ill (have good insight) Negative symptoms: - no Neurotic -

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17 . , . , . - - .
1. Disorders of sensations. Differentiation of pathological sensations (senestopaties) and real somatic sensations. Methamorphopsia.
Sensation - such form of mental activity, which reflects only to the separate properties of phenomena and objects, which influence the sensory organs . Perception - the integral reflection of those phenomena or objects, which act on our sensory organs. Recognition and interpretation of sensory stimuli based chiefly on memory. Cenesthopathy: unfounded strange inexplicable sensations in bodily organs Parasthesias: An altered sensation reported by the patient in an area where the sensory nerve has been afflicted by a disease or an injury (is a sensation of tingling, pricking, or numbness of a person's skin with no apparent long-term physical effect) Quantitative disorders of the sensation: f. Anesthesia - the disorders of a feeling of pain, which are characterized by loss or decrease of the painful sensitivity g. Hypaesthesia - reduction in the sensitivity to the external stimuli. (everything under the mute). h. Hyperaesthesia - is a condition that involves an abnormal increase in sensitivity to stimuli of the senses i. Cenesthesia - the special feature of the sensory reception, which is consisted in the fact that the external stimulus, addressed to one analyzer, causes simultaneously answer from some another or several analyzers. j. Hysterical anaesthesia- lost of sensory modalities due to emotional conflicts.

16

Quantitave disorders of the perception: e. Illusions misperception or misinterpretation of real external sensory stimuli f. Hallucination false sensory perceptions or mental impressions of sensory of vividness not associated with real external stimuli. g. Derealization a subjective sense that the environment is strange or unreal h. Depersonalization a subjective sense of being unreal, strange or unfamiliar to oneself

2. Differentiation harmonic, accented and psychopathic personalities. The meaning of premorbid features for the development of mental disorders.
Emphasis of the nature ()- the excessive strengthening of separate features Psychopathy () - the pathologic structure of personality with the uniqueness of the affective (anomalous type of reaction to the stress situations) (provoke interpersonal conflict) Premorbid (Preceding the occurrence of disease) special features of the personality of the patient: temperament, nature, the personality. Nature is the basis of personality. 1. Temperament - the individual method of reaction, which is inherited, the dynamics of mental activity. 2. Nature - individual style of contact and behavior, manufactured on the basis of temperament, the individual steady uniqueness of man (nature - this always act). 3. Personality - the united entire education of the properties of personality, which consists of the constitutional and acquired qualities.

3. Outpatient psychiatric service. Dispensary observation, ethical issues.

Consultative-therapeutic aid: - by doctor- psychiatrist (with patient a greement and without the patients agreement in case of danger for the patients or their surrounding due to their illness) Clinic observation (after the person, who suffers chronic and protracted mental disorder with the heavy, steadfast and frequently aggravated unhealthy manifestations, independently agree or of the agreement of theirs lawful representative) Tasks of psychoneurological dispensaries and psychiatric offices: - Consultative, diagnostic, therapeutic, psycho prophylactic rehabilitative aid under the extra hospital conditions; - all forms of the psychiatric examination of forensic, military, temporary disablement; - social-welfare aid and assistance in job placement of those, who suffer mental disorders; - resolve questions about guardianship; - consultation on lawful questions and other forms of juridical aid

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18 . , . , . ( ). , , . .
1. Hysterical neurosis (Dissociative Disorders). Somatoform Disorders. Descriptive features.
IV. V. VI. F44 in ICD-10 Characterized by physical or psychological symptoms for which no physical cause can be identified but which are linked to meaningful physiological stressors Symptoms : Neurological (loss or change in sensory or motor function, blindness,seizures) Somatic (headache, stomachache, painful extremities, diff swallowing, dysmenorrhea) Psychological (amnesia, false visions, fears, crying/laughing, substance abuse)

2. Acute and chronic mental disorders due to a general infection. Clinical features, course, treatment.
General paralysis of Insane (GPI)- syphilitic psychosis which appears in some patient in 10-15 years after infection. (encephalopathy) Symptoms of encephalitis: lost of insight, euphoria, dementia, severe personality changes, delusion of grandeur (Nobility or greatness of character)

17

 Neurological sign: Argyll-Robertson symptoms (pupil not constrict), asymmetry tendon reflexes, positive Wassermann test ( 95%) Treatment: antibiotics, iodotheraphy, bismuth drug

3. Clinical subtypes of psychomotor excitation and their treatment.

Catatonic purposeless, impulsive absence or poor reaction to the acts of spectators (muteness stereotypical manneristic posture and facial expression echolalia and echopraxia purposeful Marked striving to personal contacts increase drives Facial expression of happiness (sometimes anger)

Maniacal

Hysterical - stress induced - reactions to the act of spectators demonstrative behavior (loud cries, sobbing

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19 1. , . . 2. , . , , , . 3- . . . .
1. Subtypes of epileptic seizures.Differential Diagnosis ofepileptic seizure and hysterical attack.
Primary generalized Abrupt loss of consciousness (up to coma) Total amnesia Simultaneous changes in all areas in EEG e.g. Petit mal (absence of myoclonic seizures) grand mal (tonic, clonic, tonic-clonic, atonic) Partial (focal) seizures No loss of consciousness or partial changed consciousness Partial or no amnesia Focal changes in EEG e.g. abrupt attacks of hallucination, delusion Secondary generalized seizures Differential diagnosis Grand mal Abrupt spontaneous onset with self injury. Nocturnal seizures are common The face is pale at the beginning and then cyanotic No deep reflexes Stereotypical tonic and clonic expression Meaningless facial expression Duration 30s to 2 min Spikes, pathological waves on EEG Total amnesia Hysterical convulsions

18

Induced by emotional stress Careful falling without injury Flushing or no changes in face colour Deep reflexes Non stereotyped asynchronous body movements Facial expression of suffering, fear or delight Long duration (several min up to an hour) No specific EEG changes Partial amnesia

2. Anorexia nervosa, bulimia nervosa. Descriptive features. Principles of treatment.

Anorexia nervosa - extreme low body weight and distorted body image with fear of gaining weight by starving, excessive exercise, diet pills and diuretics - Lanuga, dry skin, cold intolerance, hair loss, bradycardia, hypotension, edema, hypothymia - Complication: arrhythmia and mitral valve prolapsed, increase in nitrogen, partial diabetes, stress, osteoporosis Bulimia nervosa - recurrent binge eating and self induced vomiting, fasting, enemas and laxatives. - dizziness, hypotension, dental problems, abrasion of knuckles - Complication : electrolyte imbalance , GIT disorder, dental problems, esophagitis, peptic ulcer Etiology: Sociocultural Cognitive behavior Biochemical Familial Feminist psychology Dietary factor

Treatment - Pschotheraphy - Psychodynamics - Family - Nutritional counseling Pharmacotheraphy

3. Tranquilizers. Subtypes, side effects, practical applications

Treat anxiety and sleep disorder Short term relief (2-4weeks) of severe and disabling anxiety Short treatment of insomnia and excitement Anticonvulsants (epileptic seizures) Muscle relaxants

Examples: Nitrazepam, diazepam, clonazepam,lorazepam,phenazepam

Side effects : Difficulty concentrating A "floating" or disconnected sensation Depressed heartbeat Depressed breathing Excessive sleep and sleepiness Mental confusion and memory loss Addiction

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19

 20 . , . . 3- .
1. Catatonia. Descriptive features.
Catatonic -

purposeless, impulsive absence or poor reaction to the acts of spectators (muteness stereotypical manneristic posture and facial expression echolalia (involuntary repetition of speech) and echopraxia (imitation)

2. Mental disorders due to a general medical condition.

degenerative cerebral diseases: Alzheimer and Pick disease Asthenia - can be the only manifestation of a psychic illness - increased fatigue (from the morning itself), the difficulty of the concentration of attention, retarding perception, emotional lability, increased vulnerability, rapid distractedness. Hyperesthesia is characteristic Neurosis-like disturbances - they appear with the loading of somatical state, from the neuroses The affective disorders endoreactive (dysthymic- a mood disorder characterized by mild depression) depression Psychopathy-like disorders - the growth of selfishness, suspiciousness, the alerted and hostile attitude to those surrounding Delirious states - against the background of depressive, astheno- depressive, alarming- depressive state. Is more frequent this delirium of relation, censure (an expression of strong disapproval or harsh criticism), material damage. The state of the darkened consciousness - the episodes of stupefaction (to amaze; astonish.), which appear against the asthenic-adinamic background. Depersonalization is possible. The mains characteristic of the syndromes of the darkened consciousness - blurry condition, rapid passage from one syndrome to another, appearance against the aesthetic background.

3. Principles and methods of treatment of schizophrenia.

Antipsychotics (haloperidol, clozapine, chlorpromazine) Psychotherapy

Ticket 21 21 . , , .

.. , , , . .
1. Psychoorganic syndrome (organic disorders due to a general medical condition). Descriptive features.
Watlter-bleuler triad: memory liability, emotional incontinence and disturbances and decrease intelectuallity. (difficulties in registration, difficulties in understanding, difficulties in keeping feeling) Patients become helpless, having difficulty to adapt to the new situation, bad understanding. Stages: asthenic, plosive, euphonic, insensitive (apathetic) Organic disorder include trauma, tumour, intoxication (alcohol), epilepsy, degenerative disease (Alzheimer, Pick disease), as a consquencs of somatic diseases (atheroskerosis, endocrine pathology) Clinical: delirium, paroxysmal disorders, impairment of memory and intelligence. Irreversible disorders. Diagnostic: based on symptoms and syndromes. In 1st stage: increase manifestations of mental weakness and increased fatiagability Later: disorder of attention, memory and intellectual activity, emotional disorder.

20

Classification: degenerative cerebral diseases, cerebral arteriosclerosis, tumours, trauma, and infections.

2. Reactive psychoses (Acute Stress Disorder with psychotic features). Subtypes.Treatment.

Reactive psychoses - group of the neuropsychic disorders , which appear under the effect of the psycho-injury and having the specific clinical picture , which reaches the expressed psychotic level Reactive psychoses divide into the sharp (affective- shock reactions) and the prolonged (chronic). They separate among the latter: reactive depression, reactive paranoid and different hysterical reactive psychoses (twilight loss of consciousness, pseudo-dementiapuerilism (Childish behavior in an adult), Ganzerovsky syndrome (twilight stupefaction, deliberately give wrong answers to simple questions are not able to produce the most basic steps, do not understand the appointment of everyday items. Acute Chronic Affective stupor Reactive depression Reactive paranoid hysterical psychoses - syndrome of pseudo-dementia (with pseudodementia they are characteristic improper actions and behavior in the simple circumstances)

The general criteria of reactive psychoses were proposed by K Jasper: a. Agreement in the time of the beginning of disease with the psycho-injury situation b. The reflection of this situation in the clinical picture of disease, in the experiences of patient c. Recovery in proportion to the permission of the psycho-injury situation.

3. Psychotherapy in general medical practice.

Method of working with patients to assist them to modify, change or reduce factors/disorders that interfere with effective living. Methods: Individual Couples Family Group

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22 . , . . . , . . , .
1. Hypochondria. Subtypes.
Concept: The persistent conviction that one is or is likely to become ill, often involving symptoms when illness is neither present nor likely, and persisting despite reassurance and medical evidence to the contrary
Subtypes : Somatoform pain disorder Somatization Hypochondrial

2. Acute and chronic substance-related disorders. Clinical features, treatment.

1. Neuroinfections: Encephalitis - acute psychosis with the loss of consciousness according to the type of the exogenous type of reactions, affective, delirious manifestations, psycho-organic and Korsakoff's syndromes. Forms - delirious, amential- delirious, maniacal. Meningitis - asthenia in prodrome (An early symptom indicating the onset of an attack or a disease), at the peak of disease - the loss of consciousness. Serous meningitis - with epidemic parotitis - sleepiness, apathy, psychosensory disorders. Delirium, hallucination Intoxication + clouding of consciousness, organic stupor and coma

2.

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3. Mood stabilizers. Subtypes, side effects, practical applications, indications and contraindications.
A mood stabilizer is a psychiatric medication used to treat mood disorders characterized by intense and sustained mood shifts. Usage : bipolar affective (mood) disorder, resistant mania, resistant depression, epilepsy, trigeminal neuralsia Types : Anticonvulsants (Valproic acid, lamotrigine, carbamazepine) Lithium salt Side effects increased thirst and urination, nausea, weight gain and a fine trembling of the hands tiredness, vomiting and diarrhea, blurred vision, impaired memory, difficulty concentrating, skin changes dizziness, drowsiness, blurred vision, confusion, muscle tremor, nausea, vomiting or mild cramps, increased sensitivity to sun, skin sensitivity and rashes and poor co-ordination. Contraindications : pregnancy, brestfeeding

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23 . , ( , , ). . ( ). , , . . , , .
1. Delusion. Definition.Classification according to the content and structure of syndromes.
Delusion - false belief of great value to a patient, cannot be corrected by reasoning Primary delusion independent disorder of thought which are not associated with other mental dysfunction Secondary delusion secondary disorder of thought which represent the disturbance of other mental function. Systemized delusion false idea confirm with some logic associations Nonsystematised delusion fragmentary, not associated with false ideas - Persecutory delusions - Acute delusion - Depressive delusions( - Chronic delusion: cotard-thinks hes dead) - paranoia (primary systemized idea of persecutions, jealousy - Grandiose delusions without hallucination - paranoid (hallucination and delusional states with persecutory ideas) - paraphrenia (hallucination and delusional states with bizarre ideas)

2. Mental disorders due to HIV disease. Clinical features, course, treatment.

Organic mental disorder: specific - Difficulties in registration (up to amnesia) - Difficulties in understanding (up to dementia) - Difficulties in keeping feeling (disphoria or emotional incontinence) Additional symptoms: - Changes in personality and behavior - Neurological sign and symptoms - Asthenia - Somatic symptoms (headache) - Weather sensitivity Treatment :antipsychosis, counseling, psychotherapy memory intellectual affective

3. Behavioral psychotherapy: subtypes, indications.

psychotherapeutic approach that aims to solve problems concerning dysfunctional emotions, behaviors and cognitions through a goal-oriented, systematic procedure . Subtypes cognitive therapy,

22

 rational emotive behavior therapy multimodal therapy Indications o Anxiety disorders o Mood disorders o Insomnia o Severe mental disorders

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24 . . , , . . , , , . . . , .
1. The concept of consciousness in psychiatry. Jaspers criteria of the pathology of consciousness.
Concept: indicate a state of awareness of self and environment Found deficiencies of: Grasp/ comprehension/ attention, orientation, thinking, retention Syndromes : a. Deterioration : - clouding of consciousness - organic stupor - coma b. Obscured consciousness - Delirium - acute psychosis with illusions and true hallucination, excitement, disorientation in time, place and situation. - Amentia - deep disorder of consciousness with incoherence - Oneiroid state - dream like state with dual orientation - Twilight state - action maybe performed without conscious coalition and without any remembrance afterward

2. Drug addiction. Subtypes, principles of therapy, prevention.

Concept: Compulsive physiological and psychological need for a habit-forming substance Classification: - opiates (opium, morphine) - stimulant (cocaine) - psychotomimetica (marijuana) - sedative (barbiturates) - lighter fluids (glue, acetone) - anticholinergic (belladonna) Treatment: a. Stopping drugs - consider the physical state of patients, their age and working life of narcotic. To simultaneously deprive of the preparation is possible only of the young, physically healthy persons. b. Demorphinazation - 3 to 10 days; specific periods and daily doses of morphine depend on the duration of the application of a narcotic and achieved dose. c. Hypoglycaemic (sub-comatose doses of insulin) d. Tranquilizers (seduxen) and neuroleptics (aminazine e. Sodium hydroxybutyrate 20% solution on 20 ml of 3 times per day Preventive maintenance. medical and lawful knowledge a. Normal moral-psychological climate in the subdivision b. Warning the embezzlement of narcotic drugs from the drugstores and the close cooperation of the command of part with the law-enforcement agencies. c. Special attention should be given to early development among the soldiers of the persons, who suffer toxicomania (study of young completion, solid inspections, the sudden inspections of the personal effect).

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d.

The persons, noted in the use of narcotic drugs, need the consultation of psychiatrist and the dynamic observation of the doctor of part.

3. Classification of psychotropic drugs. Types of psychopharmacotherapy: cropped, supportive and preventive.

Antipsychotics (Neuroleptics) Antidepressants Mood stabilizer Tranquilizer and sedative Stimulating drugs Nootrops treat symptoms of psychoses (haloperidol, clozapine, methophenazine) treat depressed mood (imipramine, mitriptiline) treat elevated mood (lithium, carbamazepine) treat anxiety and sleep disorders (nitrazepam, diazepam) increase activity, decrease appetite, disturb sleep, intensify psychosis (ccaffeince, amphetamine, mesocarb) treat deficiency of memory and thinking. (pyracetam, pyruditol, ACE inhibitor)

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25 1. , , . 2. , (). , . 3. . .
1. Intellectual Disabilities. Descriptive features.

Dementia: the acquired dementia (total, partial). Special forms: schizophrenic, epileptic,psychopathic. Loss of intelligence after a period of its normal development Symptoms: deterioration of memory, reduction in other cognitive abilities is characterized by weakening criticism and thinking, Absence of the loss of consciousness on the duration of the period of the time, reduction in the emotional control or motivation (emotional liability; irritability; apathy) a. Organic: Dysmnestic (arteriosclerotic)

primary marked disorder of memory Slight deficiency in understanding Mild personality changes Good insight (sadness due to illness)

b.

Total (atrophy, frontal lobe tumors) - primary marked impairment of understanding - severe personality changes - poor insight Epileptic - severe personality changes (abulia, autism, apathy) - marked impairment of cognitive and memory - poor vocabulary and preservatives thinking Schizophrenic dementia : - severe personality changes - Marked cognitive difficulties - Absence or mild memory disorders

Oligophrenias - congenital or early (till 3 years old) states of mental underdevelopment with the preferred defeat of intellect. Retarded intellectual and cognitive development. Causes: genetic (chromosomal and inherited) embryopathy (intoxication, Rubella) fetopathy and perinatal pathology (hypoxia, trauma, infections) Level : based on IQ Moronic 50 69 Imbecile35 20 Idiocy below 20

2. . Stress-related disorders.Jaspers criteria on psychogenic disorders.

24

Diagnostic triad Jaspers K: - close temporary relation between stressor and the development of the disease - symptoms show the reflection of the nature of the traumatic experiences - generally benign course of the disease with the complete recovery after psychological problems solved. Clinical classification: - acute stress induces psychoses a. Acute stress reaction b. Hysterical psychoses c. Reactive depression d. Reactive paranoid e. Posttraumatic stress disorder neuroses a. Neurasthenia symptoms of asthenia (fatigability with irritability) linked to meaningful psychological stressors. b. Hysteria (somatic disorder characterize by physical or psychological symptoms for which no physical cause can be identified but which are linked to meaningful psychological stressor) c. Obsessive-phobic neurosis (a spectrum of illness appeared with the symptoms of anxiety, unreasonable fears, obsessions and rituals, associated with internal conflict)

3. Subtypes of personality reactions to disease. Principles of treatment.

Consensual reaction Of or relating to a reflexive response of one body structure following stimulation of another, such as the concurrent constriction of one pupil in response to light shined in the other. Calm reaction - it is characteristic for the emotionally steady persons. Such patients adequately react to all instructions of doctor, accurately are carried out medical and sanitary measures. Unconscious reaction - patient of its illness is the form of psychological protection, which should not be completely removed, especially with the severe (incurable) illnesses, Aftersensation reaction - after the happy end of disease the patients are located in the authority of unhealthy doubts, the expectation of relapse, reveal tendency toward the hypochondriac manifestations. Negative reaction - patients are suspicious, distrustful, with difficulty they pour into the contact with the doctor Panicky reaction - patients are found in the authority of fear, it is easily suggested, they are treated simultaneously in the different therapeutic establishments in different doctors. Destructive reaction - patients behave inadequately, ignoring all instructions of the doctor in attendance of the consequence of this reaction frequently they are unfavorable.

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26 . . . . , , . . . . , .
1. Paraphrenia. Descriptive features.
Paraphrenia is a group of psychotic illnesses distinct from paranoia and from schizophrenia.The onset occurs around age 40. Characterized by hallucination and delusional states with bizarre ideas of grandeur or persecution, delusional memories, falsification of memory usually associated with mental automatism, often non -systemized

2. Dependence on hypnotics and sedatives. Clinical features, treatment, prevention.

Sedative: - barbiturates, benzodiazepines Duration: 4-6 hours, up to 12-20 hours (diazepam, phenobarbitol) Symptoms of intoxicatioins: motor retardation, nystagmus, incoordination, slurred speech, impairment in attention or memory Withdrawal symptoms: tremor, insomnia, anxiety, tachycardia, delirium, seizures

25

Treatment: - Basic PrinciplesBarbiturate dependences: a. Detoxification is a prerequisite in the treatment of these disorders. b. barbiturates must be withheld from a comatose or grossly intoxicated patient until these symptoms clear. c. Diazepam (Valium,15 to 25 mg four times daily) may be substituted for the abused barbiturate. barbiturate detoxification can be accomplished in a 14 day period, but longer detoxification may be required. - Medical Treatment Of Benzodiazepine Dependence a. Start withdrawing the patient on diazepam (Valium), 15 to 25 mg four times daily. Administer sufficient additional diazepam to suppress signs of increased withdrawal (e.g., increased pulse, increased blood pressure, or increased perspiration). Once a diazepam dose is reached which suppresses signs of withdrawal, continue for 2 days then start decreasing by 10% per day. When the diazepam dose approaches 10%, reduce the dose slowly over 3 to 4 days and then discontinue. b. Generally, benzodiazepine detoxification can be accomplished in a 14 day period, but longer detoxification may be required. - Psychosocial Treatment - Psychotherapy - Behavior Therapy (teaches the sedative abuser other ways to reduce anxiety) by relaxation training, assertiveness training, self-control skills, and new strategies to master the environment are emphasized.

3. Iatrogenic disorders (doctor-induced disorders). Mental disorders condition (nosogenic reactions). Definition, treatment, prevention.

due to a general medical

refer to inadvertent adverse effects or complications caused by or resulting from medical treatment or advice. In addition to harmful consequences of actions by physicians, iatrogenesis can also refer to actions by other healthcare professionals, such as psychologists, therapists, pharmacists, nurses, dentists, and others. Examples of iatrogenesis: medical error wrong prescription illegible handwriting negligence faulty procedures, techniques, information, or methods failure in life support instruments prescription drug interaction adverse effects of prescription drugs over-use of drugs leading to antibiotic resistance in bacteria nosocomial infection blood transfusion harmful emotional distress from the ascription of mental pathology nomenclature for transient personal problems

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27 1 . , . 2. . . . , . 3. . , , .
1. Memory disorders. Clinical forms, diagnostic value.
Hypermnesia :exaggerated degree of retention and recall Hypomnesia : difficulties of registration, retention and recall of memories Korsakovs syndrome : failure to register minute memory, anterograde and retrograde amnesia, amnestic disorientation, paramnesia Amnesia : gap, loss of memories but not the ability to register Organic amnesia Retrograde amnesia

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 Anterograde amnesia Progressive Psychogenic Paramnesia Allomnesia : filling of gaps in memory by real experience but of the other time period Confabulation : unconscious filling of gaps in memory by imagined or untrue experiences that patient believes but have no basis in fact.

2. Depressive neurosis (dysthymia). Descriptive features. Treatment.

Neurotic depression: mild case of depression with the predominance of sad mood, adinamia (no movement), frequently with the obtrusive ideas. First stage - somatical complaints: fluctuation AD, vegetative dystonia, disfunction of , tachycardia. Causes: 1) unsuccessful life 2) prolonged separation. Complaints: reduction in the activity, disturbance of sleep, feeling of anxiety, palpitation and fear for the heart, the weakness and the breakdown in the morning hours, hope for bright future, tearfulness, taciturn originally b-th begin to tell about itself unknown people. Treatment: antidepressants stimulating, with the anxiety - small doses of the neuroleptics. + strengthen overalling - vitamins, nootropes, the Phiz- Ra, massage. Group psychotherapy.

3. Shock therapy. Electro-convulsive contraindications.Ethical issues.

therapy.Practical

applications,

indications

and

psychiatric treatment in which seizures are electrically induced in anesthetized patients for therapeutic effect. Today, ECT is most often used as a treatment for severe major depression which has not r esponded to other treatment, and is also used in the treatment of mania (often in bipolar disorder), catatonia and schizophrenia. Electroconvulsive therapy can differ in its application in three ways: electrode placement, length of time that the stimulus is given, and the property of the stimulus. The variance of these three forms of application have significant differences in both adverse side effects and positive outcomes. After treatment, drug therapy can be continued, and some patients receive continuation/maintenance ECT. Effects: o Effects on memory o Controversy over long-term effects on general cognition o Effects on brain structure o Effects in pregnancy

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28 1. . , . , . . , , . . . , , .
1. Depression. Descriptive features. Criteria of severity of depression.
Depressive syndrome - lowered, depressed mood, intellectual and motor retardation It is not only characterize by mental suffering, but also is accompanied by the physical painful sensations (vital melancholy): by discomfort in the epigastral region, by gravity or by pains in the region of heart. Depressive syndrome is characterized by the depressive triad: hypothymia (depressed mood, melancholy, melancholy, anxiety, apathy) retarding thinking (depletion of thinking, few thoughts, they they flow slowly, they are riveted to the unpleasant events) motional retardation (slowing of movement and speech). Depression with anxiety up to agitation depression associated with severe anxiety, excitement and motor restlessness, more common for patient of involution age. High suicidal risk Masked depression manifested by somatic symptoms (heartache, headache, stomachache, hypertension)

1. 2. 3.

2. Mental disorders associated with pregnancy and childbirth. Psychotic disorder due to an operation. Clinical features, course, treatment.
Postnatal blues

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Transitory emotional disturbances, including short-lived episodes of irritability, crying, depression and emotional lability, occurring in the first postpartum week. Onset : 3rd day of postpartum Puerperal psychosis Can occur following childbirth : affective schizophrenic and acute organic Onset : between day 3 and day 14 postpartum Treatment : bonding with baby, ECT

3. Help with single seizures. Serial seizures and status epilepticus. Clinical features, treatment.
Status epilepticus (SE) is a life-threatening condition in which the brain is in a state of persistent seizure. defined as one continuous unremitting seizure lasting longer than 30 minutes, or recurrent seizures without regaining consciousness between seizures for greater than 30 minutes (or shorter with medical intervention). Treatment : anticonvulsant (diazepam, valproates, eclampsia)

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29 . . . . , , . . , .
1. Delirium. Descriptive features.
Delirium - acute psychosis with illusions and true hallucination, excitement, disorientation in time, place and situation Disturbance of consciousness (that is, reduced clarity of awareness of the environment, with reduced ability to focus, sustain, or shift attention) Change in cognition (e.g., problem-solving impairment or memory impairment) or a perceptual disturbance Onset of hours to days, and tendency to fluctuate.

2. Psychosomatic illnesses. The concept, types, treatment.

degenerative cerebral diseases: Alzheimer and Pick disease Asthenia - can be the only manifestation of a psychic illness - increased fatigue (from the morning itself), the difficulty of the concentration of attention, retarding perception, emotional lability, increased vulnerability, rapid distractedness. Hyperesthesia is characteristic Neurosis-like disturbances - they appear with the loading of somatical state, from the neuroses The affective disorders endoreactive (dysthymic- a mood disorder characterized by mild depression) Psychopathy-like disorders - the growth of selfishness, suspiciousness, the alerted and hostile attitude to those surrounding Delirious states - against the background of depressive, astheno- depressive, alarming- depressive state. Is more frequent this delirium of relation, censure (an expression of strong disapproval or harsh criticism), material damage. The state of the darkened consciousness - the episodes of stupefaction (to amaze; astonish.), which appear against the asthenic-adinamic background. Depersonalization is possible. The mains characteristic of the syndromes of the darkened consciousness - blurry condition, rapid passage from one syndrome to another, appearance against the aesthetic background.

3. Nootropic drugs. Practical applications, indications and contraindications.

Bioactive substances which correct deficiency of memory and thinking Improve mental function by cognition, memory intelligence, and concentration

Applications o o o

Stimulants Dopaminergics Memory enhancement Cholinergics

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GABA blockers Glutamate activators cAMP o Serotonergics o Anti-depression, adaptogenic (antistress), and mood stabilization o Blood flow and metabolic function o Nerve growth stimulation and brain cell protection E.g. pyracetam, GABA, pyriditol, ACTH, acetylcholinesterase inhibitors

Contraindications :should not be taken by patients with serious renal insufficiency (creatinine clearance lower than 20 ml/min).

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30 . . . . . . . . . ( ), .
1. Psychosensory disorders. Disorders of the body scheme. Clinical features.
Illusion - misperception or misinterpretation of real external sensory stimuli Hallucination - false memory perception or mental impressions of sensory vividness not associated with real stimuli. True hallucination : - bright vivid perception, natural way of perception, confidence with the fact that other people have it (perception) too Pseudohallucination:- lack of vividness, other perception( internal vision of hearing), perceptions only for the patients himself. Derealisation : a subjective sense that the environment is strange or unreal Depersonalisation : a subjective sense of being unreal, strange or unfamiliar to oneself

2. Alcohol abuse. Stages of Alcohol Dependence.Age, and gender features.The concept of symptomatic alcohol dependence.
A disorder characterized by the excessive consumption of and dependence on alcoholic beverages, leading to physical and psychological harm and impaired social and vocational functioning. Classification by E.M Jellinek Alpha, beta, gamma, delta, epsilon alcoholism Russian: stage 1- only psychological dependences Stage 2- psychological and physiological dependence Stage 3- reduced tolerance Alcohol withdrawal syndromes - Symptoms: desire for alcohol, affective instability (dysphoria, depression, anxiety), neurologic symptoms (nystagmus, tremor, atxia), malaise, sleep disorder, arterial hypertension, tachycardia - Treatmnent: detoxication fluids by mouth or intravein, diuretics, vitamins, nootrops. Alcohol psychoses e. Delirium tremens acute psychosis induced by severe alcohol withdrawal syndrome (illusion, true hallucinations) - Treatment: sedative (benzodiazepines, barbiturates), treatment of withdrawal syndromes-fluids, diuretics, nootrops, vitamins, adequate nutrition f. alcohol hallucinosis - acute psychosis induced by severe alcohol withdrawal syndromes (abundance true hallucinations) - treatment: antipsychotics, benzodiazepines Delusional alcohol psychosis - encephalopathy induced by severed alcohol delirium (amnestic syndromes with peripheral neruropathy)

g.

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- treatment: vitamin B1, nootrops h. Karsakov i. Gayet-wernicke encephalopathy - acute alcohol encephalopathy (ataxia, vestibular dysfunction, ocular motility abnormalities disorder of consciousness) - treatment: thiamin, treat cerebral oedema(diuretics, corticosteroid hormones, anticoagulant)

3. Mental disorders (syndromes and diseases) in general medical practice.

anxiety disorders, childhood disorders, eating disorders, mood disorders, cognitive disorders, personality disorders, schizophrenia and other psychotic disorders, and substance-related disorders Confused thinking Long-lasting sadness or irritability Extreme highs and lows in mood Excessive fear, worry, or anxiety Social withdrawal Dramatic changes in eating or sleeping habits Strong feelings of anger Delusions or hallucinations (seeing or hearing things that are not really there) Increasing inability to cope with daily problems and activities Thoughts of suicide Denial of obvious problems Many unexplained physical problems Abuse of drugs and/or alcohol

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31 . - , . P , . , . 3. . - , .
1. Asthenia (Chronic fatigue syndrome). Subtypes.Treatment.
CFS is a multi-systemic disease and is relatively rare by comparison. Symptoms of CFS include widespread muscle and joint pain; cognitive difficulties; chronic, often severe, mental and physical exhaustion; and other characteristic symptoms in a previously healthy and active person. CFS patients may report additional symptoms including muscle weakness, hypersensitivity, orthostatic intolerance, digestive disturbances, depression, poor immune response, and cardiac and respiratory problems Subtypes benign myalgic encephalomyelitis, chronic fatigue immune dysfunction syndrome, chronic infectious mononucleosis, epidemic myalgic encephalomyelitis, epidemic neuromyasthenia, myalgic encephalomyelitis, myalgic encephalitis, myalgic encephalopathy, post-viral fatigue syndrome

2. Differentiation harmonic, accented and psychopathic personalities. The meaning of premorbid features for the development of mental disorders.
Emphasis of the nature ()- the excessive strengthening of separate features Psychopathy () - the pathologic structure of personality with the uniqueness of the affective (anomalous type of reaction to the stress situations) (provoke interpersonal conflict)

30

Premorbid (Preceding the occurrence of disease) special features of the personality of the patient: temperament, nature, the personality. Nature is the basis of personality. 4. Temperament - the individual method of reaction, which is inherited, the dynamics of mental activity. 5. Nature - individual style of contact and behavior, manufactured on the basis of temperament, the individual steady uniqueness of man (nature - this always act). 6. Personality - the united entire education of the properties of personality, which consists of the constitutional and acquired qualities.

3. Outpatient psychiatric service. Dispensary observation, ethical issues.

Consultative-therapeutic aid: - by doctor- psychiatrist (with patient agreement and without the patients agreement in case of danger for the patients or their surrounding due to their illness) Clinic observation Tasks of psychoneurological dispensaries and psychiatric offices: Consultative, diagnostic, therapeutic, psycho prophylactic rehabilitative aid under the extra hospital conditions; all forms of the psychiatric examination of forensic, military, temporary disablement; social-welfare aid and assistance in job placement of those, who suffer mental disorders; resolve questions about guardianship; consultation on lawful questions and other forms of juridical

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32 1. . , . 2. . . 3. . .
1. Jaspers criteria of the pathology of consciousness. Syndromes of clouded consciousness.Subtypes.
a. b. c. Agreement in the time of the beginning of disease with the psycho-injury situation The reflection of this situation in the clinical picture of disease, in the experiences of patient Recovery in proportion to the permission of the psycho-injury situation.

*Retention. Orientation.Thinking. Attention 2. Classification of schizophrenia according to the course (by Mental Health Scientific Center, Russia).Subtypes of schizophrenia in ICD-10
a. b. c. d. Continous progression Pregression with acute attacks Periodic (recurrent) with slow progression Slow (sluggish) progression

3. Psychoanalysis as a psychological and medical theory. Advantages and disadvantages.

study of human psychological functioning and behavior, although it also can be applied to societies. Psychoanalysis has three applications: a method of investigation of the mind; a systematized set of theories about human behaviour; a method of treatment of psychological or emotional illness Advantage psychoanalytic treatment can clarify how patients unconsciously are their own worst enemies: how unconscious, symbolic reactions that have been stimulated by experience are causing symptoms. Disadvantages causal claims of psychoanalysis are unsupported by the available clinical evidence. alternative methods for psychotherapy, including behavior therapy, cognitive therapy theories were based too little on quantitative and experimental research, and too much on the clinical case study method

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Ticket 33 33

1. () . , . 2. (), , , . 3. . .
1. Psychomotor disorders. Types of stupor and excitation. Descriptive features.
Stupor: strange non-convenient posture, waxy flexibility (catalepsy), negativity (active and passive), automatic obedience. Catatonic - bizarre inconvenient posture - manneristic facial expressioin - muteness - negativism (often eating is absolutelu refused) - echolalia and ecoipraxia Depressive posture of suffering facial expression of sadness or anguish poor associations one word answers but not muteness the loss of appetite but no active resistance while eating

Excitement: purposeless actions, impulsive, brutality, stereotypic speech and movement (verbigerations, perseverations) Catatonic - purposeless, impulsive - absence or poor reaction to the acts of spectators (muteness - stereotypical - manneristic posture and facial expression - echolalia and echopraxia Maniacal - purposeful - Marked striving to personal contacts - increase drives - Facial expression of happiness (sometimes anger) Hysterical - stress induced - reactions to the act of spectators - demonstrative behavior (loud cries, sobbing) - histrionic posture and facial expression Non adaptive movements: echo symptoms (echopraxia, echolalia, echomimia), manneristic behavior Diagnose: amorbital (Amytal) interviews

2. Bonheoffer exogenous type of reaction. Etiological factors, subtypes. 3. Indicators of severity of depressive states. Care for depressed patients
Quantitative and qualitative alterations in cognitive processes (learning, memory, attention, perception and speed of cognitive responses). The Beck Depression Inventory (BDI, BDI-II): instruments for measuring the severity of depression consisted of twenty-one questions about how CF CFC VVVV the subject has been feeling in the last week. Each question has a set of at least four possible answer choices, ranging in intensity. For example: (0) I do not feel sad. (1) I feel sad. (2) I am sad all the time and I can't snap out of it. (3) I am so sad or unhappy that I can't stand it. When the test is scored, a value of 0 to 3 is assigned for each answer and then the total score is compared to a key to determine the depression's severity. The standard cut-offs are as follows: 09 indicates that a person is not depressed, 1018 indicates mild-moderate depression, 1929 indicates moderate-severe depression and 3063 indicates severe depression.

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Higher total scores indicate more severe depressive symptoms.

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34 1. , , . . 2. . , , , . 3. . . .
1. The distinction of illusions, hallucinations, pseudohallucinations.
Illusion- misperception or misinterpretation of real external sensory stimuli Hallucination- false memory perception or mental impressions of sensory vividness not associated with real stimuli. True hallucination: - bright vivid perception, natural way of perception, confidence with the fact that other people have it (perception) too Pseudohallucination:- lack of vividness, other perception( internal vision of hearing), perceptions only for the patients himself.

2. Sexual disorders. Clinical subtypes, treatment.

Concept: the process during which personality and sexual behavior mature through a series of stages: first oral stage and then anal stage and then phallic stage and then latency stage and finally genital stage Clinical: nymphomania (Excessive sexual desire in and behavior by a female), satyriasis (in man) Paraphilia (A sexual practice or act considered abnormal or deviant) Gender identify disorder Sexual dysfunction

3. Stages of ontogenesis of the psyche and its clinical significance. Disontogenesisof the psyche.
(,., 1969) 1. Somato-vegetative stage - 0-3 years 2. Psycho-motor -4-10 of the years 3. Affective -7-12 of the years 4. Emotional- ideational - 12-16 years (.., 1973) 17. Motor - up to 1 year 18. Sensorimotor - of up to 3 years 19. Affective - from 3 of up to 12 years 20. Ideational - from 12 of up to 14 years

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35 . , , . - . , , . .
1. Mania. Descriptive features, diagnostic value.
Characteristics of mania include rapid speech, racing thoughts, decreased need for sleep, hypersexuality, euphoria, impulsiveness, grandiosity, and an uncontrollably intense interest in goal-directed activities Indicator of mania would be if a noticeably clinically depressed person becomes suddenly cheerful, optimistic, happy, and full of energy. Other elements of mania can and often do include delusions (of grandeur, potential, or otherwise), hypersensitivity, hypersexuality, hyper-religiosity, hyperactivity, impulsiveness, talkativeness, an internal pressure to keep talking (over-explanation) or rapid speech, grandiose ideas and plans, and decreased need for sleep.

2. Mental disorders due to cerebral trauma and neuroinfections. Clinical features, course, treatment.
Trauma : Acute or chronic regressive course. Stages : Loss of consciousness (up to coma) Acute period (acute psychosis delirium) Convalescence (until asthenia) Consequences :cerebrasthenia, Korsakovs syndrome, dementia, epileptic seizures, personality disorder

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Infection : General paralysis of insane syphilitic psychosis which appears in some patients in 10-15 years after infection. Symptoms : loss of sight, euphoria, dementia, severe personality changes, delusions of grandeur. Neurological signs : Argyll-Robertson symptom, asymmetry tendon reflexes Treatment : Antibiotics, iodotherapy, bismuth drugs

3. Disorders of sleep and their treatment.

A sleep disorder (somnipathy) is a medical disorder of the sleep patterns of a person or animal. Some sleep disorders are serious enough to interfere with normal physical, mental and emotional functioning. A test commonly ordered for some sleep disorders is the polysomnogram. Broad classifications of sleep disorders Dyssomnias - A broad category of sleep disorders characterized by either hypersomnolence or insomnia. The three major subcategories include intrinsic (i.e., arising from within the body), extrinsic (seconda ry to environmental conditions or various pathologic conditions), and disturbances of circadian rhythm. MeSH i. Insomnia ii. Narcolepsy iii. Obstructive sleep apnea iv. Restless leg syndrome v. Periodic limb movement disorder vi. Hypersomnia Parasomnias i. REM sleep behaviour disorder ii. Sleep terror iii. Sleepwalking (or somnambulism) Treatments for sleep disorders generally can be grouped into four categories: behavioral/ psychotherapeutic treatments rehabilitation/management medications other somatic treatments

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36 . , . . . . . , , . .
1. Depersonalization and derealization. Descriptive features, diagnostic value.
There should be found deficiencies in Grasp, comprehension, attention (difficulties or loss of contact) Orientation (In time, situation) Thinking (poor association up to incoherence) Retention (congrade amnesia) Deterioration : - clouding of consciousness - organic stupor - coma Obscured consciousness - Delirium - acute psychosis with illusions and true hallucination, excitement, disorientation in time, place and situation. - Amentia - deep disorder of consciousness with incoherence - Oneiroid state - dream like state with dual orientation Twilight state action maybe performed without conscious coalition and without any remembrance afterward

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2. Mental retardation. Mental infantilism.The value of biological and situational factors in their formation.Treatment, rehabilitation, prevention.
Oligophrenias - congenital or early (till 3 years old) states of mental underdevelopment with the preferred defeat of intellect. Retarded intellectual and cognitive development. Causes: - genetic (chromosomal and inherited) - embryopathy (intoxication, Rubella) - fetopathy and perinatal pathology (hypoxia, trauma, infections) Level : Mild mental retardation , Moderately retarded, Severe mental retardation, Profound mental retardation Level : based on IQ (clinically) Moronic -50 69 Imbecile - 35 20 Idiocy below 20 Treatment: Train retarded children in such basic skills as bathing and feeding themselves. Training in independent living and job skills is often begun in early adulthood. The level of training depends on the degree of retardation. Mildly retarded people can often acquire the skills needed to live independently and hold an outside job. Moderate to profoundly retarded persons usually require supervised community living in a group home or other residential setting. Family therapy can help relatives of the mentally retarded develop coping skills.

3. Military psychiatric examination.

Examination is carried out by doctor- psychiatrists, for those entering the military schools, and also the garrison (To assign (troops) to a military post) and hospital military- medical commissions. Subject for examination: a. Man called up for military service - for determining their fitness for the bearing of military service and for the assistance to command in the correct distribution of draftees in parts and to the subdivisions of different branches of services; b. Those joining into the military educational institutions; c. Military personnel and the reservists (askarwataniah-liable for military service), when for other one or reasons or another arises the question about the state of their mental health; d. When discover psychic illnesses (expressed dementia, psychoses and other; Man called up for military service and soldiers are excluded to the bearing of military service. With a number of diseases (neuroses, craniocerebral injuries without the epileptic syndrome) is given the postponement from the call to army to 5 years. Subsequently the repeated examination of its mental condition is produced. If necessary prolonged observation of the patient and conducting studies examination is carried out under the conditions of hospital.

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37 . . . , , . . , , .
1. Depression.Indicators of suicidal risk.
Depressive syndrome is characterized by the depressive triad: hypothymia (depressed mood, melancholy, melancholy, anxiety, apathy) retarding thinking (depletion of thinking, few thoughts, they they flow slowly, they are riveted to the unpleasant events) motional retardation (slowing of movement and speech). Suicidal ideation Post-traumatic stress disorder (PTSD) Major depression, which is often associated with social isolation Bipolar disorder Substance abuse (particularly alcohol) Schizophrenia Borderline personality disorder

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Additionally, in adolescents: impulsive, aggressive and antisocial behavior; presence of family violence and disruption Past history (History of previous suicide attempt,Family history of suicide attempt)

2. Somatoform Disorders. Descriptive features. Treatment.

Somatoform disorder (also known as Briquet's syndrome) is a mental disorder characterized by physical symptoms that mimic physical disease or injury for which there is no identifiable physical cause. The symptoms that result from a somatoform disorder are due to mental factors. In people who have Somatoform disorder, medical test results are either normal or don't explain the person's symptoms. People who have this disorder may undergo several medical evaluations and tests to be sure that they do not have an illness related to a physical cause or central lesion. The Somatoform disorders recognized by the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association are: Conversion disorder Somatization disorder Hypochondriasis Body dysmorphic disorder Pain disorder Undifferentiated somatoform disorder - only one unexplained symptom is required for at least 6 months. Included among these disorders are false pregnancy, psychogenic urinary retention, and mass psychogenic illness (so-called mass hysteria). Treatment Electroconvulsive therapy is not effective for somatoform disorders, but it may successfully treat depression occurring in the context of a somatoform disorder. Obtain necessary studies to rule out physical causes such as myocardial infarction or appendicitis. Intravenous or oral acute sedation with benzodiazepines may be used. Avoid long-term benzodiazepines for somatoform disorders. Avoid acute or long-term narcotic analgesics for somatoform disorders.

3. Biological therapy of mental disorders. The concept, basic methods of applications.

approach to psychiatry that aims to understand mental disorder in terms of the biological function of the nervous system. It is interdisciplinary in its approach and draws on sciences such as neuroscience, psychopharmacology, biochemistry, genetics and physiology to investigate the biological bases of behaviour and psychopathology. Biopsychiatry is that branch/speciality of medicine,which deals with the study of biological function of the nervous system in mental disorders. This knowledge has been gained using imaging techniques, psychopharmacology, neuroimmunochemistry and so on. On a research level, it includes all possible biological bases of behavior - biochemical, genetic, physiological, neurological and anatomical. On a clinical level, it includes various therapies, such as drugs, diet, avoidance of environmental contaminants, exercise, and alleviation of the ad verse effects of life stress, all of which can cause measurable biochemical changes. The biological psychiatrist views all of these as possible etiologies of or remedies for mental health disorders.

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38 . , , . . , . . , .
1. Emotionaldisturbances.Descriptive features.
Depression - hypothymia (stable unreasonable feeling of sadness) - Anaesthesiapsychadolorosa (painful feeling that patient lost his feeling) Mania - hyperthymia (stable unreasonable elevation of mood) Apathy (dulled emotional tone) and abulia

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Euphoria elevated but careless mood Dysphoria unpleasant mood up to anger abd irritation Anxiety feeling of tension of uncertain danger Ambivalence coexistence of two opposing impulses toward the same thing in the same person at the same time Emotional stiffness pathologic steadfastness Emotional liability fast changes in mood from sad to happy Emotional incontinence burst to tears for little for no reason

2. Mental disorders due to brain tumor. Clinical features.

Neurological symptoms are common in onset (paralysis, disorders of co-ordination of movement, disorders of vision, epileptic seizures) If frontal lobes are impaired, the changes of character, apathy and poor insight are typical. The symptoms of cranial hypertension are common (headache with retching increasing by the morning, clouding of consciousness)

3.Cognitive therapy (CT). Indications.

Cognitive therapy seeks to help the client overcome difficulties by identifying and changing dysfunctional thinking, behavior, and emotional responses. This involves helping clients develop skills for modifying beliefs, identifying distorted thinking, relating to others in different ways, and changing behaviors. Treatment is based on collaboration between client and therapist and on testing beliefs. Therapy may consist of testing the assumptions which one makes and identifying how certain of one's usually unquestioned thoughts are distorted, unrealistic and unhelpful. Once those thoughts have been challenged, one's feelings about the subject matter of those thoughts are more easily subject to change.

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39 . . . . , , . () . , .
1. Twilight states of consciousness. Descriptive features.
Syndrome : Sudden onset Symptoms : Brutal aggression or automatic behavior, paroxysmal state with local amnesia Duration : Several minutes to hours Ending : Sudden Amnesia : Total Nosology : Epilepsy or other organic paroxysmal disorder

2. Post-traumatic stress disorder. Descriptive features, treatment.

A mixture of anxiety symptoms (panic, intrusive thoughts, memories or images of event, sleep disorders) that occur in a person who has experienced a severe psychological trauma and last long er than a month. Re-experiencing symptoms may cause problems in a persons everyday routine. They can start from the persons own thoughts and feelings. Words, objects, or situations that are reminders of the event can also trigger re experiencing. Things that remind a person of the traumatic event can trigger avoidance symptoms. These symptoms may cause a person to change his or her personal routine. For example, after a bad car accident, a person who usually drives may avoid driving or riding in a car. Hyperarousal symptoms are usually constant, instead of being triggered by things that remind one of the traumatic event. They can make the person feel stressed and angry. These symptoms may make it hard to do daily tasks, such as sleeping, eating, or concentrating. Treatment : antidepressants (citalopram,fluvoxamine, paroxetine,sertraline) anti-anxiety, psychotherapy

3. Disorders usually accompanied by suicidal thoughts and attempts. Principles of treatment of patients with suicidal thoughts.

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The most common cause is an underlying psychiatric disorders which include depression, bipolar disorder, schizophrenia, alcoholism and drug abuse. Treatment : antidepressant, psychotherapy

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40 , , . . , , . . (, , ).
1. Differentiation of dementia and mental retardation. Etiological factors.Descriptive features.
Dementia: the acquired dementia (total, partial). Special forms: schizophrenic, epileptic, psychopathic. Loss of intelligence after a period of its normal development Symptoms: deterioration of memory, reduction in other cognitive abilities is characterized by weakening criticism and thinking, Absence of the loss of consciousness on the duration of the period of the time, reduction in the emotional control or motivation (emotional liability; irritability; apathy) Organic: Dysmnestic (arteriosclerotic) Primary marked disorder of memory Slight deficiency in understanding Mild personality changes Good insight (sadness due to illness) Total (atrophy, frontal lobe tumors) primary marked impairment of understanding severe personality changes poor insight Epileptic severe personality changes (abulia, autism, apathy) marked impairment of cognitive and memory poor vocabulary and preservatives thinking Schizophrenic dementia : Severe personality changes Marked cognitive difficulties Absence or mild memory disorders Oligophrenias - congenital or early (till 3 years old) states of mental underdevelopment with the preferred defeat of intellect. Retarded intellectual and cognitive development. Causes: genetic (chromosomal and inherited) embryopathy (intoxication, Rubella) fetopathy and perinatal pathology (hypoxia, trauma, infections) Level : based on IQ Moronic 50 69 Imbecile 35 20 Idiocy below 20

2. Panic disorder. Descriptive features, treatment.

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Panic disorder is an anxiety disorder characterized by recurring severe panic attacks. It may also include significant behavioral change lasting at least a month and of ongoing worry about the implications or concern about having other attacks. Common symptoms of an attack include rapid heartbeat, perspiration, dizziness, dyspnea, trembling, uncontrollable fear, hyperventilation, etc. Some individuals deal with these events on a regular basis, sometimes daily or weekly. Treatment Antidepressants Anti-anxiety (benzodiazepine) Psychotherapy

3. Institutional and legal issues of involuntary hospitalization. The problem of information about diagnosis (the patient, relatives, third parties).
The person, who suffers mental disorder, can be hospitalized without its agreement or agreement of its lawful representative to the decision of judge, if his inspection and treatment are possible only under the stationary conditions, For 48 hours face must be examined by psychiatrists If hospitalization is recognized as that substantiated, then conclusion about this for 24 hours is sent for the law court for the location of psychiatric establishment. Assuming statement, judge simultaneously gives sanction to a stay of face in the psychiatric hospital for the period, necessary for examining the statement in the law court.

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41 . , . . , . () .

1. Disorders of sensations. Differentiation of pathological sensations (senestopaties) and real somatic sensations.
Sensation - such form of mental activity, which reflects only to the separate properties of phenomena and objects, which influence the sensory organs . Perception - the integral reflection of those phenomena or objects, which act on our sensory organs. Recognition and interpretation of sensory stimuli based chiefly on memory. Cenesthopathy: unfounded strange inexplicable sensations in bodily organs Parasthesias: An altered sensation reported by the patient in an area where the sensory nerve has been afflicted by a disease or an injury (is a sensation of tingling, pricking, or numbness of a person's skin with no apparent long-term physical effect) Quantitative disorders of the sensation: k. Anesthesia - the disorders of a feeling of pain, which are characterized by loss or decrease of the painful sensitivity l. Hypaesthesia - reduction in the sensitivity to the external stimuli. (everything under the mute). m. Hyperaesthesia - is a condition that involves an abnormal increase in sensitivity to stimuli of the senses n. Cenesthesia - the special feature of the sensory reception, which is consisted in the fact that the external stimulus, addressed to one analyzer, causes simultaneously answer from some another or several analyzers. o. Hysterical anaesthesia- lost of sensory modalities due to emotional conflicts. Quantitave disorders of the perception: i. Illusions misperception or misinterpretation of real external sensory stimuli j. Hallucination false sensory perceptions or mental impressions of sensory of vividness not associated with real external stimuli. k. Derealization a subjective sense that the environment is strange or unreal l. Depersonalization a subjective sense of being unreal, strange or unfamiliar to oneself

2. Opium abuse. Descriptive features, treatment.

Drugs : Opium, morphine, heroin

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Duration of effect 3-6h Symptoms of intoxication i. Drowsiness ii. Motor retardation iii. Altered mood iv. Pupillary constriction v. Bradycardia vi. Bradypnoe Withdrawal syndrome i. Dysphoric mood ii. Nausea iii. Muscle ache iv. Rhinorrhea v. Pupillary dilatation vi. Insomnia vii. Diarrhea

Treatment
i.

ii.

Opium detox Opium Treatment Counseling

3. Prevalence (epidemiology) of main mental disorders.

Disease Mental disorders, all forms Psychoses Senile age Reactive Schizophrenia Epilepsy Nonpsychotic disorders Neuroses Psychopathy Specific symptom and the syndrome Reactive states Psychosomatic states Epilepsy without the psychosis and the dementia Vascular diseases of the brain Other organic defeats CNS Mental backwardness (oligophrenia) Mental debility Total number of patients 3784423 34.7 % 1097070 10.0 % 128640 1.2 % 33720 0.3 % 606743 5.6 % 104895 1.0 % 1783434 16.3 % 500018 4.6 % 124957 1.1 % 369966 3.4 % 56203 0.5 % 115493 1.1 % 158999 1.5 % 123821 1.1 % 313359 2.9 % 903919 8.3 % 713821 6.5 %

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42 . , . . ( , , ). . . .
1. Depression. Differentiation of endogenous depression (depressive episode) and psychogenic depression (grief reactions).Principles of treatment.
Depressive episode: Triads :Hypothymia, retarded thinking, retarded motion Psychogenic depression : Depression as a result of irresistible loss (death, divorce, victim of crime) Suicidal behavior is possible, often with dangerous behavior, sometimes obscured consciousness

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Treatment : Mood stabilizers, antidepressants, neuroleptics, psychotherapy

2. Mental disorders due to epilepsy (paroxysmal disorders, acute, chronic and prolonged psychoses).
Personality changes and dementia due to epilepsy. Treatment. Epilepsy : group of related disorders characterized by tendency for recurrent seizures Course : chronic progressive Outcome : epileptic dementia Paroxysmal disorders With deterioration of consciousness (grand mal, petit mal, twilight states) Without deterioration of consciousness (dysphoria, paroxysmal derealisation, hallucination and delusion) Epilepsy can lead to psychiatric symptomatology (complex partial seizures of the temporal lobe) cause the symptomatology of schizophrenia and mood disorders Treatment : anticonvulsants, neuroleptics

3. Features of physical examination of mental patients.

Damages are noted (bruises, abrasion, scars). If unknown, they are described as external signs and physical deficiency. Observed the asymmetry of face, tendinous reflexes. With the presence of some forms of delirium, the negativism the patients can intentionally conceal the somatical disturbances of the thinking

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43 . , . . , , . , , .
1. Formal thought disorder. Subtypes.
Disorders of the form and stream of thought Disorder of the possession and the content of thought a. Delusion - false belief of great value to a patient, cannot be corrected by reasoning Persecutory delusions Acute delusion Depressive delusions Chronic delusion: Grandiose delusions paranoia (primary systemized idea of persecutions, jealousy without hallucination paranoid (hallucination and delusional states with persecutory ideas) paraphrenia (hallucination and delusional states with bizarre ideas) b. Overvalued ideas- sustained ideas of great personal values which is no absolutely false but inadequately significant Obsessions - pathological persistence of an irresistible thought or feeling that cannot be eliminated. Rumination (irrational burdensome operating with thought, symbols, words or numbers) Contrast ideas (irrational painful thought about possibility of dangerous or antisocial actions)

c.

2. Mental disorders due to a general medical condition (nosogenic reactions). Definition, treatment, prevention.
Transitory psychosis (loss of consciousness) Delirium acute psychosis with illusions and true hallucination, excitement, disorientation in time, place and situation. Amentia deep disorder of consciousness with incoherence Oneiroid state dream like state with dual orientation Twilight state action maybe performed without conscious coalition and without any remembrance afterward Korsakov; amnesia ( loss of memory but not the ability to remember), paramnesia (allomnesia- filling gaps with true real experiences but during other time period; confabulation-imagined untrue experiences between memory gaps ) Psycho-organic (disorder of attention, memory and intellectual activity, emotional disorder classify as: degenerative cerebral diseases, cerebral arteriosclerosis, tumours, trauma, and infections.).

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3. Psychostimulants. Practical applications, indications and contraindications.

Stimulants are used both individually and clinically for therapeutic purposes in the treatment of a number of indications, including the following: To counteract lethargy and fatigue throughout the day while at work or while doing other activities. To reduce sleepiness and to keep the person awake when necessary, as well as to treat narcolepsy. To decrease appetite and promote weight loss, as well as to treat obesity. To improve concentration and focus while at work or school, especially for those with attentional disorders such as ADHD. Occasionally, they are also used to treat clinical depression. Contraindications Anxiety Sleep disorders Loss of appetite Dependence

Ticket 4 4

44 (). . . . , . 3- () . , .
1. Obsessive-compulsive disorder. Descriptive features. Subtypes in ICD-10. Treatment.
Mental disorder characterized by intrusive thoughts that produce anxiety, by repetitive behaviors aimed at reducing anxiety, or by combinations of such thoughts (obsessions) and behaviors (compulsions). The symptoms of this anxiety disorder range from repetitive hand-washing and extensivehoarding to preoccupation with sexual, religious, or aggressive impulses. ICD-10 :F60.5 Anankastic (OCD) Treatment 1. Psychotherapy 2. SSRI : Paroxetine, Sertraline, Fluoxetine, Escitalopram 3. Tricyclic Antidepressant : Clomipramine

2. Mental disorders due to vascular diseases of the brain. Clinical features, treatment.
Systemic disease with slow progression and evident waving course. Cerebral symptoms coexist with features of ischemia of heart or extremities. The first symptoms are asthenia and hypomnesia Dementia appears later, insight is rather good (partial dementia-F01)

3. Psychiatry and clinical psychology. The subject, common features and differences.
Psychiatry - these are the medical science, which studies the disturbances of mental activity, their clinical manifestations, the special feature of flow, outcome, etiology and pathogenesis, epidemiology, etc Tasks of psychiatry: 1. Diagnostics of mental disorders. 2. Study of clinic, etio-protogenesis, flow and outcome of psychic illnesses. 3. Study of epidemiology of mental disorders. 4. Study of the action of medicines on the pathomorphosis of psychic illnesses. 5. Development of the methods of treating the mental pathology. 6. Development of the methods of the rehabilitation of patients with psychic illnesses. 7. Development of the methods of prophylaxis of mental pathology among the population. 8. Questions of the organization of psychiatric aid to populati on.

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45 . . , , . . . . . .
1. Disorders of attractions.
Disorders of the inclinations Disturbance of inclinations to the food: Bulimia - pathologic, sharply intensive feeling of hunger, which is frequently accompanied by general weakness and abdominal pains followed by feelings of guilt, depression, and self-condemnation. Anorexia - loss of a feeling of hunger, the absence of appetite with the presence of the physiological need for the nourishment. Polydipsia - Excessive or abnormal thirst. parorexia - Abnormal or inappropriate appetite, especially a craving for items unsuitable as food; pica ( persistent craving and compulsive eating of non-food substances). coprophagy, scatophagy Disturbance of the instinct of the self-preservation: Weakening the reflex of self-preservation. Strengthening the reflex of self-preservation. Disturbances of the sexual inclination: onanism, promiscuity (sex between many partners), group sex, hyper sexuality, erotomania - entire life in the sex, impotence, vaginism, homo and transsexual, pedophilia, incest

2. Senile and presenile dementia. Dementia of the Alzheimer's Type.Clinical features, course, treatment.
Early onset or presenile dementia is a term used to describe a range of illnesses or diseases affecting memory, thinking and other cognitive functioning in people under the age of 65. Although most dementias affect people who are mature aged and therefore less likely to be participating in the workforce, occasionally younger people (those in their 40s and 50s) are diagnosed with dementia. Senile dementia is a disease caused by degeneration of the brain cells. It is different from normal senility in the elderly in that the patient's brain function will gradually deteriorate resulting in progressive loss of memory and mental abilities, and noticeable personality changes memory impairment (impaired ability to learn new information or to recall previously learned information) one (or more) of the following cognitive disturbances: aphasia (language disturbance) apraxia (impaired ability to carry out motor activities despite intact motor function) agnosia (failure to recognize or identify objects despite intact sensory function) disturbance in executive functioning (i.e., planning, organizing, sequencing, abstracting) The course is characterized by gradual onset and continuing cognitive decline Treatment: Ach-esterase inhibitor (donepezil, galantamine) Excitatory neurotransmitter (memantine) Antipsychotic Psychotherapy

3. The conception of internal picture of disease: description, clinical significance and meaning for general practice doctors. Treatment. Ticket 46

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 46 . . . , , . - . . .
1. Depression. Differentiation of endogenous depression (depressive episode) and psychogenic depression (grief reactions).Principles of treatment.
Endogenous depression is a mood disorder that affects some people from birth and is believed to be a genetic condition. A sufferer is prone to become depressed on the advent of traumatic events, exhaustion or when under high levels of stress and may not be aware of the disorder until confronted by symptoms of depression for the first time.

2. Substance abuse. Clinical features, treatment and prevention

Concept: Compulsive physiological and psychological need for a habit-forming substance Classification: - opiates (opium, morphine) - stimulant (cocaine) - psychotomimetica (marijuana) - sedative (barbiturates) - lighter fluids (glue, acetone) - anticholinergic (belladonna) Treatment: a. Stopping drugs - consider the physical state of patients, their age and working life of narcotic. To simultaneously deprive of the preparation is possible only of the young, physically healthy persons. b. Demorphinazation - 3 to 10 days; specific periods and daily doses of morphine depend on the duration of the application of a narcotic and achieved dose. c. Hypoglycaemic (sub-comatose doses of insulin) d. Tranquilizers (seduxen) and neuroleptics (aminazine e. Sodium hydroxybutyrate 20% solution on 20 ml of 3 times per day Preventive maintenance. medical and lawful knowledge a. Normal moral-psychological climate in the subdivision b. Warning the embezzlement of narcotic drugs from the drugstores and the close cooperation of the command of part with the law-enforcement agencies. c. Special attention should be given to early development among the soldiers of the persons, who suffer toxicomania (study of young completion, solid inspections, the sudden inspections of the personal effect). d. The persons, noted in the use of narcotic drugs, need the consultation of psychiatrist and the dynamic observation of the doctor of part.

3. Forensic psychiatric examination. The criteria for insanity.Compulsory treatment. Ticket 47

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1. Oneyroid. Descriptive features.
catatonic form of schizophrenia and presents with a dream-like or nightmare-like state as a background of intensive psychopathological experiences (1) initial general-somatic and vegetative disorder; (2) delusional mood, (3) affective-delusional depersonalisation and derealisation, (4) fantastic-delusional and affective depersonalisation and derealisation, (5) illusional depersonalisation and derealisation, (6) catatonic-oneiroid state in the culmination

2. Neurasthenia, clinical features, course and treatment.

a condition with symptoms of fatigue, anxiety, headache, neuralgia anddepressed mood

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persistent and distressing symptoms of exhaustion after minor mental or physical effort including general feeling of malaise, combined with a mixed state of excitement and depression. Accompanied by one or more of these symptoms: muscular aches and pains, dizziness, tension headache, sleep disturbance, inability to relax and irritability. Inability to recover through rest, relaxation or enjoyment. Disturbed and restless, unrefreshing sleep, often troubled with dreams. Duration of over three months. Treatment : Symptomatic treatments Nonsteroidal anti-inflammatory drugs Ibuprofen Nonsedating antihistamines Balanced diet Rest Exercise - if feasible without fatigue. Antidepressants - if appropriate Low-dose tricyclic antidepressants Benzodiazepines Serotonin reuptake inhibitors Treatment of sleep problems

3. Mental hygiene and psychosocial prevention Ticket 48

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1. Overvalued ideas. Descriptive features.
Concept: sustained ideas of great personal value, which are ot absolutely false but inadequately significant un such way that it disturbs the adaptation of individual. Clinical: true ideas, poor insight, poor behavior control but possible, diagnosis subpsychotic states (initial period of psychoses), paranoid personality.

2. Alcoholic psychoses.Alcohol withdrawal hallucinatoric disorder, clinical features.

Clinical symptoms: - changes in tolerance, marked personality changes (loss of will, disregard of duty and norms behavior, moral degradation) Delirium tremens - acute psychosis induced by severe alcohol withdrawal syndrome (illusion, true hallucinations) *Treatment: sedative (benzodiazepines, barbiturates), treatment of withdrawal syndromes-fluids, diuretics, nootrops, vitamins, adequate nutrition Alcohol hallucinosis - acute psychosis induced by severe alcohol withdrawal syndromes (abundance true hallucinations) *Treatment: antipsychotics, benzodiazepines Delusional alcohol psychosis - encephalopathy induced by severed alcohol delirium (amnestic syndromes with peripheral neruropathy) *Treatment: vitamin B1, nootrops Gayet-wernicke encephalopathy - acute alcohol encephalopathy (ataxia, vestibular dysfunction, ocular motility abnormalities disorder of consciousness) *Treatment: thiamin, treat cerebral oedema(diuretics, corticosteroid hormones, anticoagulant)

3. Individual and group psychotherapeutical methods. Subtypes, indications.

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1. Bodydysmorphicdisorder (dysmorphomania).Descriptive features. Treatment. The delusional conviction that one is physically deformed or otherwise abnormal .
1. A reference to a mental disorder characterized by a normal person's obsession with an imagined defect in physical appearance; also called muscle dysmorphia, dysmorphophobia, reverse anorexia. 2. Characterized by a fear of being deformed; also called body dysmorphic disorder. 3. Relating to a persistent complaint of a perceived bodily defect that is not noticeable to others; occasionally several parts of the body are involved. Treatment : Cognitive behavioral therapy, SSRI

2. Psychoses due to acute common infections.

Neuroinfections: Encephalitis - acute psychosis with the loss of consciousness according to the type of the exogenous type of reactions, affective, delirious manifestations, psycho-organic and Korsakoff's syndromes. Forms - delirious, amential- delirious, maniacal. Meningitis - asthenia in prodrome (An early symptom indicating the onset of an attack or a disease ), at the peak of disease - the loss of consciousness. Serous meningitis - with epidemic parotitis - sleepiness, apathy, psychosensory disorders. Delirium, hallucination Intoxication + clouding of consciousness, organic stupor and coma

3. Relationship doctor-patient as a clinical factor. Ways to optimize these relationships.

Reciprocal affirmation Correspondence of features to each other in sense of personal resemblance and supplement to each other Formal sign of interaction: shythm of interchange of reinforcement remarks, reciprocal social reinforcement and punishment. Ways the optimization: being anxious, emotional - neutral, directive nondirective

Ticket 50

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1. Masked depression (depression with a predominance of somatic symptoms). Descriptive features. Principles of treatment
Masked depression manifested by somatic symptoms (heartache, headache, stomachache, hypertension) Diagnose: dexamethasone-supression test Masked depression often manifests itself as headaches, stomach pain, a nagging ache in the lower back and pain in the jaw. The root of the problem is psychological and should be treated with antidepressants

2. Mental disorders due to vascular diseases of the brain. Clinical features, treatment.
Vascular dementia

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 Memory problems; forgetfulness Dizziness Leg or arm weakness Lack of concentration Moving with rapid, shuffling steps Loss of bladder or bowel control Treatment : physiotherapy, occupational therapy, and speech therapy treating the underlying disease such as hypertension, hyperlipidemia, and diabetes mellitus. Antiplatelet agents are indicated Pentoxifylline increase cerebral blood flow Neuroprotective drugs such as nimodipine, propentofylline, and posatirelin

3. Symptoms where refusal of eating occurs and its treatment.

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