Department of nervous diseases, psychiatry and medical psychology
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Зміст 1. Actuality Aim4. List of disciplines necessary 5. Content of the theme Mycobacterium tuberculosis Infected persons 5.2. Theoretical questions 5.3. Practical training during the tutorial |
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Ministry of Health of Ukraine Bukovynian State Medical University Department of nervous diseases, psychiatry and medical psychologyApproved 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 ^ 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: 23. Teaching goal The students must know:
and be able to:
Assimilate practical skills
^ for learning theme 1
^ 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 ^ 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. ^ 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:
Changes in the morbidity structure take place in the following directions:
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^ 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:
B. Tasks for self-control 1. Typical, ordinary – II level. 2. Untypical, no ordinary – III level. C. Tests for self-control. Literature
Prepared by. assistant N.V.Bagriy Positive review Prof. assistant N.S. Karvatska |
