IntroductionSynthetic Cannabinoids were recognized as drugs of abuse since 2008, they are sold under various names (Kush, K2, Spice).ObjectivesThe Patient N., 17 years old male was admitted to the hospital with a first-time psychotic episode. He is fond of extreme sports (ski jumping, gymnastic and acrobatic elements).MethodsThe patient was fully examined.ResultsThen he was taken to the admission department. About a week before admission he fell, injuring his leg and head. After that he did not sleep, became excited, aggressive, “said strange things”. During the admission patient showed disorganized behavior, agitation, paranoid ideation, beliefs that others were inserting thoughts into his head (“thought insertion”) and that his thoughts could be read by others (“thought broadcasting”), imperative “voices”, bizarre delusional thoughts. The UDT showed positive K2 analysis. The patient was prescribed Diazepam, Zuclopenthixol, Valproic acid. No improvement observed. Haloperidol was prescribed next day. Then Haloperodol was changed to Quetiapine, and after 10 days of treatment no improvement was observed. The patient started to show catatonia symptoms such as elective mutism, mild rigidity, signs of cog-wheeling or clasp-knife rigidity. He experienced anxiety, fear, did not take care of himself. Every day he started to be aggressive, impulsive, started to experience auditory hallucinations. Due to that fact it was decided to prescribe Haloperidol, Chlorpromazine, Phenazepame, Diphenhydramine.That treatment improved behavior.ConclusionsThus, the intensive treatment with antipsychotic medications in combination with benzodiazepines and diphenhydramine is much more preferable for the management of the cases of oneiroid catatonia due to the usage of Spice.
Mental health care problem is highly significant for people who suffer from a long-lasting emotional and informational stress, especially for medical students. The aim of research is to determine the relation between the anxiety level and the psychological defense mechanism of medical students. Used methods: Taylor's method of anxiety determination and R. Plutchik's method of life styles. 66 students of the 4th course of the medical and stomatological departments were examined, among them 52 women and 14 men aged between 20 and 23. It was discovered that the average level with a tendency to high (51,51%) and high level (43,94%) were the most frequently recorded level anxiety. Though, a low and a very high level of anxiety were not registered. It means that the cohort had mainly neurotic and partially the borderline level of personality organization. For women the overstandard rates were established by regression and projection, the displacement, compensation and intellectualization rates were very low. For men- the overstandard rates were established by projection and displacement; intellectualization, substitution and reaction formation rates were very low. With the increase of anxiety rates, the average rates of denial, displacement, regression and reaction formation alsoincreased. Compensation and intellectualization had the opposite effect during the increase of anxiety level. Thus, the psycho-prophylactic and psycho-corrective methods for students should be based on their psychological peculiarities. In practical terms, this means determining real reasons of many conflicts, predicting your own behavior and the behavior of other people in emotionally meaningful situations.
The aim — to analyze the results of the use of endovascular revascularization methods for acute lower limb ischemia (ALLI) caused by thromboses or embolisms of the lower limb arteries.Materials and methods. An evaluation of the results of revascularization with the use of endovascular interventions in 108 patients with ALLI was performed. Depending on the treatment method, patients were divided into two groups. The first group included 78 patients who had intra‑arterial catheter‑directed thrombolysis, the second group included 30 patients after percutaneous aspiration or mechanical thrombectomy. If hemodynamically significant residual stenoses of arteries which caused thrombosis remained after thrombolysis or percutaneous thrombectomy, balloon angioplasty or stenting were used.Results and discussion. Technical success was achieved in 73 % of patients who underwent thrombolysis. Endovascular or surgical interventions in addition to thrombolysis were performed in 45 % of patients. The number of perioperative complications was 27 %, of which hemorrhagic — 14 %, including intracranial hemorrhages — 3 %. The number of larger amputations was 21 %, mortality — 8 %. The technical success of aspiration thrombectomy was 83 %, mechanical thrombectomy — 100 %. In most cases additional endovascular interventions were required to eliminate residual stenoses.Conclusions. Endovascular revascularization is an effective method for the treatment of acute lower limb ischemia. Majority of patients after thrombolysis and percutaneous thrombectomy have residual stenotic lesions of arteries which caused thrombosis and require additional endovascular or surgical treatment.
Mental health is an essential element of the human, social and economic capital of the nation. Leading mental health criteria based on such factors as adaptation, socialization and individualization. Given this view, one of the valid assessment of the performance of integrated mental health and the effectiveness of treatment should be considered as quality of life, defined by WHO. The aim was to investigate the quality of life of patients with hypothyroidism with non-psychotic mental disorders. We examined 132 patients with hypothyroidism. The age of patients ranged from 25 to 55 years. The main group included 108 patients with non-psychotic mental disorders, which are dominated asthenia (27.78 %), asthenic-depressive (32.41%) and asthenic-anxiety disorders (18.52%). The control group consisted of 24 patients with hypothyroidism without mental disorders. Quality of life was assessed using a questionnaire developed by Mezzich, Cohen, Ruiperez, Liu & Yoon (1999), covering the three main components of quality of life: subjective wellbeing/satisfaction, fulfillment of social roles, external living conditions. Found a significant difference in quality of life in patients with main and control group. The average in the overall perception of life (sense of satisfaction and happiness in general) in the main group was 5.19±1.15, in the control group 7.50±2.25. Thus, mental disorders in hypothyroidism require further in-depth research in order to develop an adequate concept of early diagnosis and appropriate correction. The main conclusion is that patients with hypothyroidism really need psychiatric consultation and treatment should include not only endocrinological influence but neuropharmacological and psychological too.
The application of a comprehensive, integrative, systemic approach to the examination of patients with abnormal thyroid gland has to lie in the basis of planning strategies and tactics of medical programs such patients. On this point of view we consider that non- psychotic mental disorders are developing on the basis of both organic and adaptation levels. Population researches showed that the majority of patients with endocrinological pathology suffer from one of the three DCPR syndromes: irritant mood, demoralization thrown in (desperation), persistant somatization. The task of our work was to investigate mechanisms of psychological defense in patients with hyperthyroidism with non-psychotic mental disorders. One hundred and twenty-five patients were examined. Non-psychotic mental disorders with different syndromologic structure were found in 76% of patients (study group), among which anxious-asthenic (38.95%), anxiety and depression (23.16%) were dominant. The method of Robert Plutchik for assessment of the mechanisms of defense was used. In asthenic syndrome we found excessive functioning of negation and regression, inadequate functioning of intellectualization. In patients with astheno-anxious syndrome inadequate functioning of negation, intellectualization, compensation, and excessive repression contributed to the formation of the sensations of anxiety. Excessive compensation, projection, reactive formation generally affected the structure of the asteno-depressive syndrome. The lack of displacing of reactive formation, repression and excessive intellectualization in a complex influenced to the structuring of anxious-depressive syndrome. In hypochondrical syndrome projection, regression and negation were the basis of the formation of clinical picture. Thus, meaningful relationships between intrapsychic level of functioning and syndromological structure of non-psychotic disorders were installed.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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