The quality of medical care for patients with amyotrophic lateral sclerosis (ALS) in the Russian Federation is analyzed taking into account the cooperation of patients. Two hundred and fifty-one patients with ALS were observed. Ninety-nine patients, including 16 who were followed up, were examined. Other patients (n=152) were consulted indirectly including 28 followed up. It has been shown that 79,8% of the patients are characterized by the low level of cooperation with neurologists regardless of the quality of medical care; 8.3% of patients are managed in facilities (or by physicians), which don't use the International standard of ALS management. Only 11.9% of patients receive medical care in accordance with this standard and in these cases, the high level of cooperation of the patients with medical services was recorded. A dual system that combines the services provided by medical insurance, private treatment facilities, charity organizations, structures of medical/social care with different levels of availability and methods of consumer-provider interactions is the most effective.
Differential diagnosis of incurable and potentially curable neurological diseases is an urgent problem of modern neurology. The authors present a case report of subacute herpes virus myelitis, a rare complication of herpes infection by Varicella-Zoster virus. The differential diagnosis with amyotrophic lateral sclerosis is described.
КРАТКОЕ СООБЩЕНИЕБоковой амиотрофический склероз (БАС) -нейро-дегенеративное заболевание, которое сопровождается по-степенным наступлением полной обездвиженности, на-рушениями речи, глотания, дыхания и в ряде случаев ког-нитивными нарушениями вплоть до деменции [1,2]. Примерно у 1 / 2 больных БАС, по данным зарубежных ав-торов [3], наблюдается депрессия, требующая постоянно-го наблюдения психиатром и/или психотерапевтом. БАС ложится тяжелым бременем на семью больного, особенно лиц, осуществляющих уход за больным, что не может не отражаться на психическом состоянии последних. Есть данные [1,4] Цель исследования -изучение особенностей психических нарушений больных боковым амиотрофическим склерозом (БАС) и членов их семей. Материал и методы. Обследовали 118 больных БАС и 97 членов их семей. Оценка психического состояния проводилась по данным клинического обследования, по шкале Гамильтона и шкале лобно-височной деменции. Результаты и заключение. Психические расстройства выявлены у 101 (85%) больного БАС и у 51 (52,5%) члена их семей. У пациентов с БАС отмечались разные ситуационные расстройства, среди которых незначительно преобладала ситуационная депрессия, в редких случаях имело место сочетание БАС с эндогенными психическими заболеваниями. У 33 (28%) пациентов отмечались когнитивные нарушения, достигавшие степени деменции в 4,2% случаев. Среди членов семей больных БАС были выявлены только ситуационные психические расстройства с явным преобладанием (28%) тревожных состояний. Привычными интоксикациями (табакокурение, лекарственная зависимость и др.) страдали 49 (41,5%) больных БАС и 80 (82,4%) членов их семей. Наличие тревожных и других психических расстройств у больных часто приводило к отказу от сотрудничества с врачами и отказу от лечения. Рекомендуется постоянный патронаж семей больных БАС специалистами неврологической и психотерапевтической служб и оказание им помощи с учетом психического состояния. Ключевые слова: боковой амиотрофический склероз (БАС), психические расстройства, члены семей больных.Objective. Mental disorders in patients with lateral amyotrophic sclerosis (AMS) and their family members were studied. Material and methods. Authors examined 118 AMS patients and 97 their family members. Mental status was assessed using Hamilton scale and the frontotemporal dementia scale. Results. Mental disorders were identified in 101 (85%) of AMS patients and in 51 (52.5%) of their family members. The patients had situational disorders, with a slight prevalence of situational depression. Sometimes AMS was comorbid to endogenous mental diseases. Cognitive impairment that reached the diagnostic threshold of dementia was observed in 4.2% of the patients. The family members had only situational disorders with distinct predominance (28%) of anxiety states. Common intoxications (tobacco smoking, drug addiction etc) were noted in 49 (41.5%) of AMS patients and 80 (82.4%) of their family members. Anxiety and other mental disorders often resulted in the noncompliance with physician recommendation and refusal of treatmen...
The quality of medical care for patients with amyotrophic lateral sclerosis (ALS) in the Russian Federation is analyzed taking into account the cooperation of patients. Two hundred and fifty-one patients with ALS were observed. Ninety-nine patients, including 16 who were followed up, were examined. Other patients (n=152) were consulted indirectly including 28 followed up. It has been shown that 79.8% of the patients are characterized by the low level of cooperation with neurologists regardless of the quality of medical care; 8.3% of patients are managed in facilities (or by physicians), which don't use the International standard of ALS management. Only 11.9% of patients receive medical care in accordance with this standard and in these cases, the high level of cooperation of the patients with medical services was recorded. A dual system that combines the services provided by medical insurance, private treatment facilities, charity organizations, structures of medical/social care with different levels of availability and methods of consumer-provider interactions is the most effective.
118 ALS patients and 97 members of their families were examined. All patients and relatives were observed by psychiatrists. The assessment was carried out on the Hamilton Depression Scale (for patients and members of their families) and the scale of frontotemporal dementia (for patients). Psychiatric disorders were revealed in 101 ALS patients (85%) and in 51 members of their families (52.5%) (Significantly more frequently in ALS patients, p<0.05). The spectrum of situational disorders in ALS patients was represented relatively evenly with insignificant predominance of situational depression. Rare cases of combination of ALS with endogenous psychiatric disorders were described. In 33 patients (28%), frontotemporal cognitive impairments reaching the level of dementia were observed in 4.2% of cases. Among members of families of ALS patients, only situational psychiatric disorders with obvious predominance of anxiety (28%, p<0.05) were revealed. 49 ALS patients (41.5%) and 80 members of their families (82.4%) suffered from habitual intoxications (significantly more frequently in family members, p<0.05). High share of anxiety disorders leads to the refusal from cooperation with professional physicians (73-76%), rejection of aggressive treatment methods (74.5%), addressing to cheaters and burden connected with unjustified material expenses (29.6% of cases). Constant nursing of families of ALS patients by neurological and psychotherapeutical services with involvement of psychiatrists and narcologists in individual cases is recommended, which could provide increase of the number of life-saving procedures at ALS and improvement of the quality of life of patients and members of their families.Citation: Levitsky GN, Psychiatric disorders and their medical-social consequences in patients with amyotrophic lateral sclerosis and members of their families.Citation: Levitsky GN, Psychiatric disorders and their medical-social consequences in patients with amyotrophic lateral sclerosis and members of their families.
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