Ministry of Health of Ukraine Bukovynian State Medical University icon

Ministry of Health of Ukraine Bukovynian State Medical University




Скачати 89.66 Kb.
НазваMinistry of Health of Ukraine Bukovynian State Medical University
Дата10.07.2012
Розмір89.66 Kb.
ТипДокументи


Ministry of Health of Ukraine

Bukovynian State Medical University


“Approved”

on the methodical meeting

of the Department of neurology, psychiatry

and medical psychology nm. S.M.Savenko

“____” ___________ 2009 (Report № __).

Chief of the Department

_______________________

Professor V.M. Pashkovsky


Methodical INSTRUCTION

for 4-th year students of medical faculty №2

(the speciality “medical affair”)

for independent work during preparing to practical class


Theme 26: Mood (affective disoders). Clinical

displays, types of motion. Principles of therapy.


MODULE 2. SPECIAL (NOSOLOGY) PSYCHIATRY


Topical module 6. Polyetiological mental disorders.


Сhernivtsi, 2009


1. Actuality of theme:

^ AFFECTIVE DISORDERS

The word “affect” is a synonym for “emotion” and “mood”, and affective disorders are so named because their main feature is abnormality of mood. It is part of normal experience to feel un­happy at times of adversity and elated at times of good fortune. Depressed mood is also a component of many psychiatric syn­dromes and occurs commonly with physical illness; elation can oc­cur as part of several psychiatric disorders. The central features of these syndromes are on the one hand depressed mood, pessimistic thinking, lack of enjoyment, reduced energy, and slowness, and on the other hand elevated mood, over ­activity, and self important ideas. The first is called depressive dis­order; the second is called mania (or, if it is not severe, hypomania).

Depressive disorder is frequent in general and hospital practice but is often undetected. Unrecognized depressive disorder is a com­mon cause of distress, and also of slow recovery from physical ill­ness. Therefore it is important that all doctors should be able to recognize the condition, treat the less severe cases, and identify those requiring specialist care because of suicidal risk or for other reasons. Mania is less common than depressive disorder. Never­theless it is important that the mania is recognized in its early stages because in the later stages the patient becomes increasingly unwill­ing to accept treatment.


2. Duration of practical classes - 2 hours.


3. ^ EDUCATIONAL PURPOSE

3.1. To know:

  1. Etiology and pathogenesis of bipolar affective disoders.

  2. Clinical manifestations of manic episode.

  3. Clinical manifestations of depressive episode.

  4. Classifications of depressive disoders.

  5. Somatic and neurotic signs of bipolar affective disoders.

  6. The types of motion of affective disorders.

  7. Treatment of patients with mania.

  8. Treatment of patients with depression.

  9. Prophylactic of affective disorders.


3.2. Able:

  1. To diagnose basic symptoms of affective disorders.

  2. To diagnose somatic and neurotic signs of bipolar affective disoders.

  3. To give first aid about manic excitement.

  4. To give first aid about depressive (melancholik) excitement.

  5. To conduct differential diagnosis.


^ 3.3. To capture practical skills:

  1. To collect anamnesis in patients on affective disorders.

  2. To collect family anamnesis.

  3. To diagnose manic and depressive disoders.

  4. To prescribe a treatment of patients on affective disorders.

  5. To conduct artificial feeding of patients with affective disorders.



^ 4. INTERSUBJECT INTEGRATION (base level of preparation).


Names of previous disciplines

Skills are got


1. Normal and pathologic physiology.


2. General psychology.


3. Medical psychology.


4. Medical genetic.


1. To know physiology and pathologic physiology of HNA, types of HNA.

2. To know and determine psychological features thinking, emotion and behaviour of human.

3. To describe state of thinking, emotional, will activity of different types of personality.

4.To possess of methods examination genetic diseases of human.


5. Advices to students.


5.1. ^ CONTENTS OF THEME.

Etiology and Pathogenesis

A. Biochemical Factors: Although many differ­ences in biochemical indices have been described when bipolar patients are compared to normal control subjects, there is no agreement about which alterations have etiologic significance and which are secondary effects or epiphenomena. Since the "switch" from depression into mania (and vice versa) can occur in minutes, attempts have been made to identify bio­chemical changes that might be associated with the switch. Specific changes in brain monoamine neuro­transmitter metabolism and receptor function appear to be the most likely mechanisms. Although now re­garded as too simplistic, the catecholamine hypothesis suggested that catecholamine deficiency was associated with motor retardation and depression, while catecholamine excess could result in excitement and euphoria. Increases in dopaminergic function and adre­nergic-cholinergic system imbalance have been re­ported during manic episodes. Overall, however, there have been few biologic studies of mania, since the nature of the syndrome interferes with the necessary compliance with research procedures.

Electrolyte disturbances have also been found in bipolar disorders and may represent a defect of cellular membrane function. In general, sodium retention in­creases during depression, together with increased potassium and water excretion. The reverse is true during manic intervals. Others investigating the role of regulatory enzymes have reported alterations in monoamine oxidase (MAO) and catechol-O-meth-yltransferase (COMT) activity. A variety of neuro­endocrine changes have also been reported for pa­tients with bipolar disorder who are in the depressed phase. About half of both bipolar and unipolar de­pressed patients show evidence of any or all of the following during a severe depressive episode: in­creased adrenal glucocorticoid function, decreased thyroid-stimulating hormone response to thyrotropin-releasing hormone, decreased basal prolactin levels, and decreased growth hormone response to insulin challenge. Although several studies have also reported significant differences between bipolar patients in the depressed phase and patients with unipolar disorder, the findings are preliminary and must await confirma­tion.

B. Psychosocial Factors: There is no reliable evidence that psychosocial factors cause bipolar disorder, though such influences may precipitate manic or depressed bipolar states and may in fact be necessary for the expression of symptomatology in milder bipolar syndromes. A project deadline at work, for example, may result in decreased sleep and in­creased psychosocial stress, which in turn may trigger a mild manic episode in certain susceptible individ­uals. Retrospective analyses are unreliable, since every examined life contains historical matter that could account for behavioral changes. Over the course of their illness, most persons with bipolar disease ex­perience manic or depressive episodes completely un­related to life experiences. Recent research in biologic circadian rhythmicity indicates that subtle changes in the light-dark cycle (eg, seasonal variations) are a better predictor of risk.
^

Mood (affective) disorders
(F30-F39)


This block contains disorders in which the fundamental disturbance is a change in affect or mood to depression (with or without associated anxiety) or to elation. The mood change is usually accompanied by a change in the overall level of activity; most of the other symptoms are either secondary to, or easily understood in the context of, the change in mood and activity. Most of these disorders tend to be recurrent and the onset of individual episodes can often be related to stressful events or situations.




F30

Manic episode




All the subdivisions of this category should be used only for a single episode. Hypomanic or manic episodes in individuals who have had one or more previous affective episodes (depressive, hypomanic, manic, or mixed) should be coded as bipolar affective disorder (F31.-).

F30.0

Hypomania




A disorder characterized by a persistent mild elevation of mood, increased energy and activity, and usually marked feelings of well-being and both physical and mental efficiency. Increased sociability, talkativeness, over-familiarity, increased sexual energy, and a decreased need for sleep are often present but not to the extent that they lead to severe disruption of work or result in social rejection. Irritability, conceit, and boorish behaviour may take the place of the more usual euphoric sociability. The disturbances of mood and behaviour are not accompanied by hallucinations or delusions.

F30.1

Mania without psychotic symptoms




Mood is elevated out of keeping with the patient's circumstances and may vary from carefree joviality to almost uncontrollable excitement. Elation is accompanied by increased energy, resulting in overactivity, pressure of speech, and a decreased need for sleep. Attention cannot be sustained, and there is often marked distractibility. Self-esteem is often inflated with grandiose ideas and overconfidence. Loss of normal social inhibitions may result in behaviour that is reckless, foolhardy, or inappropriate to the circumstances, and out of character.

F30.2

Mania with psychotic symptoms




In addition to the clinical picture described in F30.1, delusions (usually grandiose) or hallucinations (usually of voices speaking directly to the patient) are present, or the excitement, excessive motor activity, and flight of ideas are so extreme that the subject is incomprehensible or inaccessible to ordinary communication.

F31

Bipolar affective disorder




A disorder characterized by two or more episodes in which the patient's mood and activity levels are significantly disturbed, this disturbance consisting on some occasions of an elevation of mood and increased energy and activity (hypomania or mania) and on others of a lowering of mood and decreased energy and activity (depression). Repeated episodes of hypomania or mania only are classified as bipolar.

F31.0

Bipolar affective disorder, current episode hypomanic




The patient is currently hypomanic, and has had at least one other affective episode (hypomanic, manic, depressive, or mixed) in the past.

F31.1

Bipolar affective disorder, current episode manic without psychotic symptoms




The patient is currently manic, without psychotic symptoms (as in F30.1), and has had at least one other affective episode (hypomanic, manic, depressive, or mixed) in the past.

F31.2

Bipolar affective disorder, current episode manic with psychotic symptoms




The patient is currently manic, with psychotic symptoms (as in F30.2), and has had at least one other affective episode (hypomanic, manic, depressive, or mixed) in the past.

F31.3

Bipolar affective disorder, current episode mild or moderate depression




The patient is currently depressed, as in a depressive episode of either mild or moderate severity (F32.0 or F32.1), and has had at least one authenticated hypomanic, manic, or mixed affective episode in the past.

F31.4

Bipolar affective disorder, current episode severe depression without psychotic symptoms




The patient is currently depressed, as in severe depressive episode without psychotic symptoms (F32.2), and has had at least one authenticated hypomanic, manic, or mixed affective episode in the past.

F31.5

Bipolar affective disorder, current episode severe depression with psychotic symptoms




The patient is currently depressed, as in severe depressive episode with psychotic symptoms (F32.3), and has had at least one authenticated hypomanic, manic, or mixed affective episode in the past.

F31.6

Bipolar affective disorder, current episode mixed




The patient has had at least one authenticated hypomanic, manic, depressive, or mixed affective episode in the past, and currently exhibits either a mixture or a rapid alteration of manic and depressive symptoms.

F31.7

Bipolar affective disorder, currently in remission




The patient has had at least one authenticated hypomanic, manic, or mixed affective episode in the past, and at least one other affective episode (hypomanic, manic, depressive, or mixed) in addition, but is not currently suffering from any significant mood disturbance, and has not done so for several months. Periods of remission during prophylactic treatment should be coded here.

F32

Depressive episode




In typical mild, moderate, or severe depressive episodes, the patient suffers from lowering of mood, reduction of energy, and decrease in activity. Capacity for enjoyment, interest, and concentration is reduced, and marked tiredness after even minimum effort is common. Sleep is usually disturbed and appetite diminished. Self-esteem and self-confidence are almost always reduced and, even in the mild form, some ideas of guilt or worthlessness are often present. The lowered mood varies little from day to day, is unresponsive to circumstances and may be accompanied by so-called "somatic" symptoms, such as loss of interest and pleasurable feelings, waking in the morning several hours before the usual time, depression worst in the morning, marked psychomotor retardation, agitation, loss of appetite, weight loss, and loss of libido. Depending upon the number and severity of the symptoms, a depressive episode may be specified as mild, moderate or severe.

F32.0

Mild depressive episode




Two or three of the above symptoms are usually present. The patient is usually distressed by these but will probably be able to continue with most activities.



F32.1

Moderate depressive episode




Four or more of the above symptoms are usually present and the patient is likely to have great difficulty in continuing with ordinary activities



F32.2

Severe depressive episode without psychotic symptoms




An episode of depression in which several of the above symptoms are marked and distressing, typically loss of self-esteem and ideas of worthlessness or guilt. Suicidal thoughts and acts are common and a number of "somatic" symptoms are usually present.

F32.3

Severe depressive episode with psychotic symptoms




An episode of depression as described in F32.2, but with the presence of hallucinations, delusions, psychomotor retardation, or stupor so severe that ordinary social activities are impossible; there may be danger to life from suicide, dehydration, or starvation. The hallucinations and delusions may or may not be mood-congruent.




F33

Recurrent depressive disorder




A disorder characterized by repeated episodes of depression as described for depressive episode (F32.-), without any history of independent episodes of mood elevation and increased energy (mania). There may, however, be brief episodes of mild mood elevation and overactivity (hypomania) immediately after a depressive episode, sometimes precipitated by antidepressant treatment. The more severe forms of recurrent depressive disorder (F33.2 and F33.3) have much in common with earlier concepts such as manic-depressive depression, melancholia, vital depression and endogenous depression. The first episode may occur at any age from childhood to old age, the onset may be either acute or insidious, and the duration varies from a few weeks to many months. The risk that a patient with recurrent depressive disorder will have an episode of mania never disappears completely, however many depressive episodes have been experienced. If such an episode does occur, the diagnosis should be changed to bipolar affective disorder (F31.-).

F33.0

Recurrent depressive disorder, current episode mild




A disorder characterized by repeated episodes of depression, the current episode being mild, as in F32.0, and without any history of mania.

F33.1

Recurrent depressive disorder, current episode moderate




A disorder characterized by repeated episodes of depression, the current episode being of moderate severity, as in F32.1, and without any history of mania.

F33.2

Recurrent depressive disorder, current episode severe without psychotic symptoms




A disorder characterized by repeated episodes of depression, the current episode being severe without psychotic symptoms, as in F32.2, and without any history of mania.

F33.3

Recurrent depressive disorder, current episode severe with psychotic symptoms




A disorder characterized by repeated episodes of depression, the current episode being severe with psychotic symptoms, as in F32.3, and with no previous episodes of mania.

F33.4

Recurrent depressive disorder, currently in remission




The patient has had two or more depressive episodes as described in F33.0-F33.3, in the past, but has been free from depressive symptoms for several months.

F34

Persistent mood [affective] disorders




Persistent and usually fluctuating disorders of mood in which the majority of the individual episodes are not sufficiently severe to warrant being described as hypomanic or mild depressive episodes. Because they last for many years, and sometimes for the greater part of the patient's adult life, they involve considerable distress and disability. In some instances, recurrent or single manic or depressive episodes may become superimposed on a persistent affective disorder.

F34.0

Cyclothymia




A persistent instability of mood involving numerous periods of depression and mild elation, none of which is sufficiently severe or prolonged to justify a diagnosis of bipolar affective disorder (F31.-) or recurrent depressive disorder (F33.-). This disorder is frequently found in the relatives of patients with bipolar affective disorder. Some patients with cyclothymia eventually develop bipolar affective disorder.

F34.1

Dysthymia




A chronic depression of mood, lasting at least several years, which is not sufficiently severe, or in which individual episodes are not sufficiently prolonged, to justify a diagnosis of severe, moderate, or mild recurrent depressive disorder (F33.-).


^ Treatment of Depressive Disorder

Standard Antidepressant Drugs. A wide range of antidepressant drugs has been tested in clinical trials. The first to be introduced, and still the standards against which others are judged, are the tri­cyclic drugs imipramine and amitriptyline. These drugs are effec­tive in both mild and severe depressive disorders; in severe disor­ders they are as effective as ECT, but they take 2 weeks or more to achieve an effect while ECT has a more rapid action.

Newer Antidepressant Drugs. Many antidepressant drugs have been developed since imipramine and amitriptyline were first in­troduced, but none has been shown to have a greater or more rapid effect. If a depressive disorder fails to respond to full doses of imi­pramine or amitriptyline, there is no evidence that it will respond to another drug, therefore, the value of alternatives resides in dif­ferences in side-effects and toxicity in overdose.

Monoamine Oxidase Inhibitors. These drugs are generally less effective than tricyclics for severe depressive disorders and no more effective for the mild disorders. However, some cases fail to respond to tricyclic antidepressants but do respond to monoamine oxidase inhibitors. These drugs reach their maximum effect slowly and up to 6 weeks may be needed. Because monoamine oxidase inhibitors potentiate the effects of pressor amines including tyramine (found in some common foods) and synthetic amines used as decongestants and vasoconstrictors, these interactions can cause dangerous increas­es in blood pressure. Therefore it is better not to use these drugs as the first treatment but to reserve them for patients who have not improved with adequate dosage of a tricyclic drug.

It has been reported that the effect of a tricyclic and a monoam­ine oxidase inhibitor in combination is greater than that of either drug alone, but this report has not been confirmed by convincing clinical trials.

^ Electroconvulsive Therapy. Clinical trials have shown that the antidepressant action of ECT is quicker than that of tricyclics - it starts earlier and is significantly greater after 4 weeks of treat­ment. After 6 months, however, the results of the two treatments are similar. ECT is most effective for severe depressive disorders, particularly those with marked weight loss, early-morning wak­ening, retardation, and delusions. It is much less effective when there is evidence of poor premorbid adjustment, hypochondriacal and histrionic features, and a fluctuating course, features that also predict a poor response to imipramine. Delusions and retardation are the best predictors of improvement with ECT as against im­provement during ECT placebo treatment. Patients with a depres­sive disorder and delusions also respond better to ECT than to tri­cyclic antidepressants, and so ECT seems to be the treatment of choice for this group.

Lithium. Lithium is generally used to prevent mood disorder, but it can also be used to treat depressive disorder. Lithium has a ther­apeutic effect in the acute stage of depressive disorders, but it is less than that of tricyclic drugs; hence lithium is seldom used for this purpose, either as a first treatment or after failed tricyclic ther­apy. However, there is some evidence that combined treatment. With lithium and a tricyclic antidepressant, or with lithium and a monoamine oxidase inhibitor, is effective in patients who have not responded to a single antidepressant. Both forms of combined treat­ment should be initiated by a specialist and used cautiously, par­ticularly when lithium is given with a monoamine oxidase inhibi­tor.

Psychological Treatment. All depressed patients require support­ive treatment to sustain them until improvement takes place. Such treatment has less effect than drug treatment on the biological symptoms of depression; but it can reduce interpersonal problems that are important in maintaining depressive symptoms.

^ Treatment for mania

Antipsychotic Drugs. Antipsychotic drugs such as chlorpromazine and haloperidol have proven value in the treatment of acute mania. Lithium carbonate has also been shown to be effective; how­ever, it takes a week or more to produce its effects and is there­fore not the first choice for acutely disturbed patients.

ECT (Electroconvulsive Therapy). ECT has a therapeutic ef­fect in mania as well as in depressive disorder. To produce a sustained effect, this treatment has to be given more frequently ill ma­nia than in depressive disorder (usually three times as against twice a week). Hence ECT is not a first-line treatment. ECT is occasion­ally used in the rare cases when antipsychotic drugs are ineffec­tive and the patient is so seriously disturbed that to await natural recovery is not justified.


Prevention of Relapse and Recurrence

Strictly speaking, relapse means the return of symptoms af­ter initial improvement during a single episode of illness, and re­currence means the start of a new episode of illness after recovery from the first. In practice the two terms are often inter­changeable. Continuation treatment refers to prevention of re­lapse, whilst prophylactic (or preventative) treatment refers to the prevention of recurrence; however, this distinction is not al­ways maintained.

The relapse rate for unipolar depressive disorders is reduced by antidepressant treatment for 6 months after recovery from the acute illness. Longer treatment prevents longer recurrence. Lithium carbonate also reduces recurrence, though it may be less ef­fective than tricyclic antidepressants.

For bipolar depressive disorders, continuation treatment with lithium carbonate is effective in preventing relapse into mania and is as effective as antidepressant drugs in preventing relapse into depressive disorder. Carbamazepine may be used for patients who do not respond to lithium carbonate, though the evidence for its preventative effects is less strong than for lithium. Relapse into mania may be induced by the continued use of antidepressant med­ication.

Social and psychological factors also contribute to relapse in unipolar and bipolar disorders. Marital disharmony seems to be important, particularly in the form of repeated criticism of the pa­tient by the spouse. Although there is no proof that attention to these factors is helpful, it is reasonable to try to reduce social stress­es in patients who relapse despite adequate drug treatment.

It has been proposed that cognitive therapy reduces the relapse and recurrence rate after a depressive disorder. The evidence is not yet strong enough to support the routine use of cognitive therapy, but this treatment may be tried for patients who have repeated ep­isodes of depression related to depressive forms of thinking.


^ 5.2. Theoretic QUESTIONS:

  1. Etiology and pathogenesis of bipolar affective disoders.

  2. Clinical manifestations of manic episode.

  3. Clinical manifestations of depressive episode.

  4. Classifications of depressive disoders.

  5. Somatic and neurotic signs of bipolar affective disoders.

  6. The types of motion of affective disorders.

  7. Treatment of patients with mania.

  8. Treatment of patients with depression.

  9. Prophylactic of affective disorders.



^ 5.3. Practical tasks on the class:

1. To collect anamnesis, clinical psychopathological examination of patients with mood disoders.

2. To diagnose manic and depressive episodes.

3. Make up plan of examination and treatment of patient with mood disoders.

4. Urgent help at excitement of patient with BAD.


5.4. Material for self-contrrol.


A. Questions of self-controls:

  1. Etiology and pathogenesis of bipolar affective disoders.

  2. Clinical manifestations of manic episode.

  3. Clinical manifestations of depressive episode.

  4. Classifications of depressive disoders.

  5. Somatic and neurotic signs of bipolar affective disoders.

  6. The types of motion of affective disorders.

  7. Treatment of patients with mania.

  8. Treatment of patients with depression.

  9. Prophylactic of affective disorders.


B. TESTS:

1. BAD begins in next age:

A. 10-15 years

B. 15-20 years

C. after 25 years

D. after 55 years

E. after 75 years


2. What symptoms are specific for maniac episode:

A.Rapidity association

B.High spirit

C.High psychomotor activity (excitement)

D.Rapidity of thought

E.All above mentioned


3. All signs are present about depressive episode, except:

A. Retarted thinking

B. Psychomotor retardation

C. Cloudiness of consciousness

D. Suicidal ideas

E. Guilty thoughts and self-condemnation


4. What medicines are using at maniac excitement:

A. Antidepressants

B. Antipsychotic

C. Anticonvulsive

D. Anxiolitics

E. Lithium


5. What medicines are using in remission with purpose prevent of bouts BAD:

A. Antidepressants

B. Anxiolitics

C. Lithium

D. Antipsychotic

E. Soporific


6. What antidepressant is tricyclic drugs:

A. Zoloft

B. Imipramine

C. Lithium

D. Floxetin

E. Lerivon

7. The patient is excited and restless, incessantly walks around the room, wrings her hands, weeps and groans. There is an expression of fear on her face. Asks the people around her to save her family, which is sure to be in great danger. Promises to give the people much money for rescuing her rela­tions. The personnel can’t dissuade her: the patient stays extremely anxious. Couldn't sleep for two nights, and hasn't eaten any food for three days, say­ing, “How can I eat, when my dear ones are dying?” Tried to commit sui­cide.

^ Name the syndromal diagnosis.

A. Hypochondriac syndrome

B. Anxiety and depressive syndrome

C. Agitated depression syndrome

D. Masked depression syndrome

E. Catatonic syndrome


8. A male patient 22 years old, a bank clerk, two weeks ago had flu, but didn't stay in bed and continued to work. Complains of constant pain in his throat, supposes that he “is ill with the larynx tuberculosis”, that his throat “has decomposed”, all his teeth have fallen out, and the brain “has dissolved”. Refuses to walk, because all his organs were "pasted together." Assured eve­rybody around that he has died, remaining "a living corps." His mood is gloomy and depressed. Refuses to communicate with people, because his “mouth is full of dangerous germs”.

^ What is the syndromal diagnosis?

A. Cotard's syndrome

B. Paranoiac syndrome

C. Depressive-paranoid syndrome

D. Hypochondriac syndrome

E. Paranoid syndrome


9. Patient A., female, 30 years old, at the psychiatric inpatient department lies all the time in bed, without changing her posture. Manifests no reaction to the changes in the environment, presence of other people, and sounds. Is abso­lutely devoid of activity. Doesn’t eat on her own, has to be fed from the spoon. When a doctor or some other person speaks to her, the patient doesn't answer, but seems to listen and sometimes tears appear in her eyes. Her facial expression is constantly sad. Her muscular tonus is somewhat increased.

^ Name the syndromal diagnosis:

A. Psychogenic stupor

B. Catatonic stupor

C. Asthenic stupor

D. Apathetic and abulic stupor

E. Depressive stupor


С. TASK

1. A 20-year-old patient is known as using to clash with teachers and classmates in school, to shout, to be able to throw with fists. He was detained several times for fighting and was convicted. He has changed several places of work due to conflicts and aggression. Psychiatric status: he is focused correctly, answers loudly, using obscene words. He demands "to leave him in rest "because "he does not control himself". In department he shows aggression for the most insignificant reasons. What is your preliminary diagnosis?

A. *Maniacal-depressive psychosis

B. Explosive psychopathy

C. Hysterical psychopathy

D. Hysterical neurosis

E. Schizophrenia


2. In mental status of a 22-year-old man there is a stable pathological depressed mood. The patient is sociable, replies briefly but to the point. The speech is laconic, tempo is slowed, and movements are constrained and inhibited. Speaks on the ideas of self-accusation and self-humiliation. Medications of what group are to be prescribed to this patient?

A. Tranquilizers

B. Hypnotics

C. *Antidepressants

D. Neuroleptics

E. Normotimics


3. A 32-year-old female complains of feeling too lazy, reduction of work capacity, and hopelessness of life. The suicide idea takes place. During 2 weeks before, the raised activity, uncontrollable fun and levity was observed. What is your diagnosis?

C. *Bipolar affective disorder

A. Recurrent depressive disorder

B. Schizoaffective disorder

D. Depressive episode

E. Maniacal episode


4. The mental status of a 22-year-old man is characterized by a stable pathological depressed mood. The patient is sociable, replies briefly but to the point. The speech is laconic, in slowed tempo, movements are constrained and inhibited. Speaks on the ideas of self-accusation and self-humiliation. Medications of what group are to be prescribed to this patient?

D. *Antidepressants

A. Tranquillisers

B. Neuroleptics

C. Hypnotics

E. Normotimics


5. A woman aged 35 has been suffering with pulmonary tuberculosis for 10 years. When in phthisiatric clinic, she started to act strangely: put on a gaudy make-up, gathered the other patients around her, was singing and dancing with them. Highly excited, passed all the time among males, flirted, started sexually-biased conversations. The whole night absented from the clinic ("was on a date"). What leading syndrome of mental disorders is observed?

D. *Maniacal

A. Morion-like

B. Psychopathy-like

C. Xenophobic

E. Hebephrenic


6. A 31 y.o. patient has had mental disorder for a long time. He suffers from insomnia for a long time. He has got fears, suicidal thoughts, tried to hang himself. His mood is depressed, he refuses from treatment. What measures are the most expedient for the prevention of suicide?

A. Out-patient treatment

B. Strict supervision at home

C. Psychotherapeutic conversation

D. *Admission to the mental hospital

E. Admission to the neurological department


7. A male patient, 37 years old, became too cheerful for no particular reason, he has a subjective feeling of high creative abilities, enthusiasm, elation and increased productivity, in spite of manifest disability to concentrate (impaired attention); his speed of thinking processes is too high. He is uncritical to his state, and finds it normal.

Name the syndrome:

A. Manic (non-psychotic) syndrome

B. Syndrome of dysphoria

C. Hypomanic (non-psychotic) syndrome

D. Obsessive syndrome

E. Depersonalization syndrome


^ 6. RECOMMENDED LITERATURE IS:

6.1. Basic:

  1. Clinical Psychiatry from Synopsis of Psychiatry by H.I.Kaplan, B.J.Sadock. – New York: Williams @ Wilkins. – 1997.

  2. Psychiatry. Course of lectures. – Odessa: The Odessa State Medical University. – 2005. – 336 p.

  3. Lectures.

  4. Internet resource.

6.2. Additional:

  1. Морозов Т.В., Шумский Н.Г. Введение в клиническую психиатрию. – Н.Новгород: Изд-во НГМА, 1998.

  2. Попов Ю.В., Вид В.Д. Современная клиническая психиатрия. – М., 1997.

  3. Сонник Г.Т. Психіатрія: Підручник / Г.Т.Сонник, О.К.Напрєєнко, А.М.Скрипніков. – К.: Здоров’я, 2006.     


Prepared by assistant S.D.Savka


Схожі:

Ministry of Health of Ukraine Bukovynian State Medical University iconMinistry of Health of Ukraine Bukovynian State Medical University

Ministry of Health of Ukraine Bukovynian State Medical University iconMinistry of Health of Ukraine Bukovynian State Medical University

Ministry of Health of Ukraine Bukovynian State Medical University iconMinistry of Health of Ukraine Bukovynian State Medical University

Ministry of Health of Ukraine Bukovynian State Medical University iconMinistry of Health of Ukraine Bukovynian State Medical University

Ministry of Health of Ukraine Bukovynian State Medical University iconMinistry of Health of Ukraine Bukovynian State Medical University

Ministry of Health of Ukraine Bukovynian State Medical University iconMinistry of Health of Ukraine Bukovynian State Medical University

Ministry of Health of Ukraine Bukovynian State Medical University iconMinistry of Health of Ukraine Bukovynian State Medical University

Ministry of Health of Ukraine Bukovynian State Medical University iconMinistry of health of ukraine bukovynian state medical university

Ministry of Health of Ukraine Bukovynian State Medical University iconMinistry of health of ukraine bukovynian state medical university

Ministry of Health of Ukraine Bukovynian State Medical University iconMinistry of Health of Ukraine Bukovynian State Medical University

Додайте кнопку на своєму сайті:
Документи


База даних захищена авторським правом ©zavantag.com 2000-2013
При копіюванні матеріалу обов'язкове зазначення активного посилання відкритою для індексації.
звернутися до адміністрації
Документи