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Department of nervous diseases, psychiatry and medical psychology




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Ministry of Health of Ukraine

Bukovynian State Medical University

Department of nervous diseases, psychiatry and medical psychology



Approved on the methodology meeting

of the Department of nervous diseases, psychiatry

and medical psychology

on “____” ___________ 2009 (Report No __).

Chief of the Department

_______________________

Professor V.M.Pashkovskyy


MethodOLOGical INSTRUCTION

for the lesson

Theme 7: Psychological peculiarities of patients with tuberculosis, AIDS, onco-pathology, endocrine, neurological and mental diseases. Influence on mentality of person congenital and obtained physical defects.


For 4-th year students of medical faculty No 2


Module 1. Medical psychology

Topical module 2. Practical aspects of medical psychology


Сhernivtsi, 2009


^

1. Actuality Aim

WHO estimated in 2005 that there were 484,000 new TB cases in Europe, representing 6% of the global TB burden. The Russian Federation had the 9th highest burden of TB in the world. Within European region, TB incidence varies enormously, from 5/100,000 in Sweden to 181/100,000 in Kazakhstan. High rates of TB are associated with socioeconomic crisis, health system weaknesses, HIV and multidrug-resistant TB epidemics, and poor TB control interventions among vulnerable populations. Recent analysis shows that 2.6% of all new TB cases that occurred in Europe in 2004 were attributable to HIV co-infection. In the Russian Federation, 1% of all new TB cases were estimated HIV-positive and 35% adult AIDS have died from TB. In Ukraine, estimated proportion of people co-infected with TB and HIV is 5%.

2. Hours: 2


3. Teaching goal

The students must know:

  • Influence of the psychological factors on a course of somatic disorders;

  • Psychological peculiarities of patients with tuberculosis;

  • Mechanisms of the psychological maintenance of personality;

  • Psychological peculiarities of patients with AIDS;

  • Psychological peculiarities of patients with endocrine, neurological and mental diseases.


and be able to:

  • objectively and scientifically determine the influence of the psychological factors on a course of somatic disorders;

  • interpret conditions to create healthy psychological climate in the medical environment;

  • analyze psychological peculiarities of patients with various pathologies;

  • to determine the way of communication between doctors, doctor – nurse;

  • know methods of research of personality;

  • evaluate the results of experimental-psychological research of patient’s personality and attitude toward a disease.

Assimilate practical skills

  • analyze psychological peculiarities of personality of medical workers;

  • communication with patients;

  • methods of research of «syndrome of burning out»;

  • experimental-psychological research of personality.


^ 4. List of disciplines necessary

for learning theme 1


Title of the discipline

Content of the discipline necessary for learning medical psychology

Anatomy

Brain construction

General psychology

Psychic functions of a normal person. Consciousness and self-consciousness. Psychology of personality.

Neuropsychology

Functions of different brain structures.

Normal physiology

Brain functions. Physiology of high nervous activity.


^ 5. Content of the theme


WHO estimated in 2005 that there were 484,000 new TB cases in Europe, representing 6% of the global TB burden. The Russian Federation had the 9th highest burden of TB in the world. Within European region, TB incidence varies enormously, from 5/100,000 in Sweden to 181/100,000 in Kazakhstan. High rates of TB are associated with socioeconomic crisis, health system weaknesses, HIV and multidrug-resistant TB epidemics, and poor TB control interventions among vulnerable populations. Recent analysis shows that 2.6% of all new TB cases that occurred in Europe in 2004 were attributable to HIV co-infection. In the Russian Federation, 1% of all new TB cases were estimated HIV-positive and 35% adult AIDS have died from TB. In Ukraine, estimated proportion of people co-infected with TB and HIV is 5%. TB is a significant cause of all HIV-related mortality.

TB should always be considered in immunosuppressed persons. HIV is the most potent known risk factor for progression to active TB in people with latent ^ Mycobacterium tuberculosis infection. HIV also increases the rate of recurrent TB, either due to endogenous reactivation or exogenous re-infection. Increasing TB cases in PLWHA augments the risk of TB transmission to the general community, whether or not HIV-infected. The level of immunodeficiency at which PLWHA usually develop TB is associated with higher case fatality rates.

The National TB Programme should implement DOTS, the WHO internationally-recommended strategy to control TB, whether or not patients are co-infected with HIV.

Adult pulmonary TB

Even in HIV-infected patients, pulmonary TB is still the commonest form of TB. The presentation depends on the degree of immunosuppression. Table 1 show how the clinical picture, sputum smear result and chest X-ray appearance often differ in early and late HIV infection.

Reported case rates of smear-negative pulmonary TB have increased in association with the TB/HIV co-epidemic. There is a lack of a widely available “gold standard” diagnostic test for smear-negative pulmonary TB. It is often difficult to distinguish other HIV-related pulmonary diseases from pulmonary TB. The extent of over-diagnosis of smear-negative pulmonary TB is therefore uncertain. It is important to follow recommended diagnostic guidelines as closely as possible and to ensure good quality control of sputum smear microscopy in order to diagnose smear-negative pulmonary TB as accurately as possible.

^ Infected persons who learn that they have HIV infection may go through different emotions, such as, shock, denial, anger, acceptance, bargaining, and depression. During these stages the patient or family members may need different forms of psychological support.

HIV infected persons should always be counseled before the HIV test is performed. In this pre-test counselling the patients should be prepared for undergoing testing and should be informed of how a positive test result may affect them. It is important to also discuss issues relating to shared confidentiality. When the result of the test is known patients should be counselled so that they may be able to cope and live with the result. Patients found to be HIV negative should be counselled on safe sexual behaviour and to live a lifestyle that will allow them to remain negative.

HIV positive individuals should be counselled to cope with knowing that they are HIV infected and how they may still enjoy a full and fruitful life despite the infection. However soon after learning of the result the patient will require further psychological support as they go through the different emotional stages. It is important that the patient has an open channel for access to psychological support whenever he/she needs it. As the patient goes through the different stages of grief with eventual acceptance he/she will need to talk to the counsellor so that he/she can discuss the infection and ask questions which may not be obvious at first. Counselling is a long-term process and should be carried out on a continuing basis in numerous sessions. Some patients who have accepted and living with the infection for some months or years may suddenly go into crises when he/she develops symptoms related (or un-related) to HIV infection and special counselling sessions are needed for these episodes.

Palliative care is an integral part of active total care for AIDS patients as there is no cure. Many aspects of palliative care, such as, pain management, symptom control and psychological support, are applicable early in the course of the illness. The palliative care needs of persons with AIDS vary from person to person and from illness to illness.

Psychological causes of diseases and factors of neurotization of Ukrainian population have a number of peculiarities:

  • sociopolitical instability of society;

  • economical and ideological instability of society;

  • loss of old ideals by the people and the lack of new ones;

  • looking up to religious, mystic, occult and para-scientific systems;

  • increase in the number of technological and natural disasters.

Changes in the morbidity structure take place in the following directions:

  • development of psychologically caused and neurotic diseases;

  • spreading of psychosomatic diseases;

  • earlier and more malignant onset of endogenous psychoses;

  • emergence of mass mental and behavioral disorder of religious, mystical and occult nature in the form of passive defense and aggressive destruction.


^ 5.2. Theoretical questions:

  1. Influence of the psychological factors on a course of somatic disorders;

  2. Psychological peculiarities of patients with tuberculosis;

  3. Mechanisms of the psychological maintenance of personality;

  4. Psychological peculiarities of patients with AIDS;

  5. Psychological peculiarities of patients with endocrine, neurological and mental diseases.


^ 5.3. Practical training during the tutorial

1. Clinical observation of the behavior of patients with psychosomatic disorders.

2. Research of Adaptation disturbances.


5.4. Materials for self-control

A. Questions for self-control:

  1. Influence of the psychological factors on a course of somatic disorders;

  2. Psychological peculiarities of patients with tuberculosis;

  3. Mechanisms of the psychological maintenance of personality;

  4. Psychological peculiarities of patients with AIDS;

  5. Psychological peculiarities of patients with endocrine, neurological and mental diseases.


B. Tasks for self-control

1. Typical, ordinary – II level.

2. Untypical, no ordinary – III level.

C. Tests for self-control.


Literature

  1. R.J.Gatchel An introduction to health psychology. – New York: Random house. – 386 p.

  2. Lectures.

  3. Internet resource.

  4. Вітенко І.С., Вітенко Т.І. Основи психології: Підручник для студентів вищих медичних навчальних закладів ІІІ – ІV рівнів акредитації. – Вінниця, 2001.

  5. Вітенко І.С., Чабан О.С., Бусло О.О. Сімейна медицина: психологічні аспекти діагностики, профілактики і лікування хворих. – Тернопіль, ”Укрмедкнига”, 2002.

  6. Гавенко В.Л., Вітенко І.С., Самардакова Г.О. Практикум з медичної психології. – Харків: Регіон-інформ, 2002.

  7. Квасенко А.В., Зубарев Ю.Т. Психология больного. М., 1980.

  8. Лакосина Н.Д., Ушаков Г.К. Медицинская психология. М., 1984.

  9. Менделевич В.Д. Клиническая и медицинская психология. – М.: Мед.прес., 1998.

  10. Мягков И.Ф., Боков С.Н. Медицинская психология: основы патопсихологии и психопатологии: Учебник для вузов.- М.: Издательская корпорация „Логос”, 1999.

Prepared by. assistant N.V.Bagriy

Positive review

Prof. assistant N.S. Karvatska


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