Organization and forms psychiatric care

Organization and forms psychiatric care

Development coming psychiatric care along 20. century it is possible characterize subsequently:

and) Behind time Kraepelina 70% ill received to the constitution for insane was destined to spend there lifetime (damage).

b) 30. age – professional. Querido in Amsterdam – Half Way gosling shift psychiatric services what closest to the ill (Dusek)

c) 60. age - professional. Sivadon – project Evrard – decrease perspectively permanent hospitalized on 5% of all received inmates.

d) R. 1971 – Basaglia in Italy (Triest) builds open underprivileged community – movement by both directions (from hospital out and outside in) - lame.

e) 70. age in Vienna – Gabriel and next: step by step succeed in reduce number beds in large psychiatric institutions at preservation of the number of medical personnel (e.g . Vienna – Baumgartner Hoehe from 2.500 on 1.000 during 10 years, behind contemporary construction specialty arrangement: detoxification, Karlsburg, gerontodomy, net extramuralnich services, acute bed in universal hospitals etc ..).

f) In USA e.g . fell number beds in psychiatric arrangements, so that in r. 1995 got on level r. 1900.

g) At our place happens to adjustment psychiatric care in 90. years in terms of gradual dispraise beds in medical institution e.g . Prague Bohnice from 1.750 on 1.400 at preservation middle health personnel and increase number doctors. Opening centre critical intervention, endowment that the interlocks underprivileged community and snug living and so on




Moravian instance: PL Kromeriz from 1.800 beds in r. 1990 step by step on 1.200 beds at increasing how of the number of SZP so and doctors and psychologists (from 600 on 700).





Basic articles specialty psychiatric care

1. Stationary care and) entire
b) partial

2. Ambulatory care and) outpatient psychiatry clinic
b) social psychiatric services
3. Complementary care
and) Daily centre and night sanatoria
b) Sheltered workshops, study bullpen centre, protected seats in companies
c) Snug living
d) Socioterapeuticke clubs
e) Co - operative insider ill and their related


Applicability system psychiatric care is given reservation treatment, rehabilitation and attendance how medical so and social near acute, unexpired cost and chronic mental disorders.


Ad. 1

Over benefits ambulatory treatment above hospitalization is yet up to the present day psychiatric hospitalization behind optimum conditions that cannon be thought apart from. Long - term aim is ferry big current psychiatric medical institution with institutional conception psychiatric hospitalization and complementary care to the nurse arrangement integrated to the appropriate areas, event. cities.
Considering well constructed ambulatory, complementary and in part stationary care is WHO indicated output bedrock number psychiatric bed 0,5 on 1.000 inhabitant. Today's reality and at well constructed system care, e.g . in Austria be lying around 0,7 psych. beds on 1.000 inhabitant.
In our rates interlock sick - bed care above all psychiatric medical institution (88%). In 20 medical institution is 10.096 beds (datum from r. 1994). Further are psychiatric detachment universal hospitals (inclusive psychiatric clinician) with 1.438 beds on 25 detachments (datum from r. 1994). Reality is such, that the during 1 year is hospitalized in psychiatric sick - bed arrangements 40 – 50 thousand persons, from that more than half repeatedly.






Ad. 2

and) Psychiatric ambulatory care would had proceed in what perhaps biggest breadth, with regard to placing, because nature most mental disorders requires, to wasn't interrupted daily customs inmate - Ova life en famille, occupation and his social surroundings. Till this time be often ascertained, that the often have to inmate be hospitalized only therefore, that the is till this time little ambulatory arrangement. To the system ambulatory care do arithmetics how psychiatrists in independent ambulances, so ambulance at psychiatric odd. hospital, clinic or medical institution.
Supposed need: 1 psychiatrist on 20 yew. inhabitant.

b) Social psychiatric service costs to the extent ambulance service. To chronically mentally ill or handicapped (cephalonia), then significant group from general psychiatric care coming psychiatrist, prohibitive sufficient promotive help.
Spectrum treatment social psychiatric service disordered, disabled that the they need after stationary stay next medical procuration in conception biopsychosocialniho setting, open out from pre – and posthospitalizacni care, ambulatory activities, critical intervention, as far as after work with related inmates and next social rehabilitative procuration.


Ad. 3

Partial hospitalization:

In principle is daily clinic built - in like connecting link between ambulatory care and hospitalization, which offers definite benefits against current stationary treatment:

• Patients keep bigger part autarchy and social contacts
• Is necessitated their own initiative

To the daily clinic can be received:

• Acutely ill by all the sorts mental disorders that the don't need full hospitalization
• Patients after medical stay in psychiatric arrangement,
near nichz would meanwhile ambulatory care fall short

Like organizationally best showed form so - called bound daily clinic that the is administratively associated to psychiatric clinic or detachment and at the same time exercises in personal premises.

Daily and night sanatoria:

Significant moment these arrangement is holding ill in original environment, significant is possibility work herewith environment – structure therapeutic time programme, that should have been for inmate contribution and interesting in so far, to to the daily or night sanatoria regularly return.This bypass roads among stay in psychiatric install oneself independent movement in common life it is important for that kind inmates, near nichz all - day stay in psychiatric arrangement isn't for various reasons possible or near psychotic inmates, near nichz stationary care isn't necessary.

Sheltered workshops, study bullpen centre, protected seats:

Common purpose visitors these arrangement is learn inmates regularity in attendance, working habits, regular contact with alike disabled thereby restraint always augmentative and deepening social isolation. Does here systematic training specialty skill with the aim of return to procedure. Last but not least is imposition and escalation self - respect inmates, escalation confidence in personal possibility thereby and escalation personal self - importance. Like objective group inmates see above all men unfaulted schizophrenic circle only rarely as well as more difficult neuroses and disturbances personalities. To the leaching criteria do arithmetics men dependent, Psycho - organic syndromes, cephalonia and heavy anethopathy.

Imposition snug workshops and study bullpen centres in common sense is:

and) again - enlistment inmate to the working life (occupation) and to the normal common life

b) illumination, to what extent is such return possible and purposeful

c) realist plans and perspective coping life, contribution to increasing quality of life chronically disordered

Among special office do arithmetics:

and) in procedure mastered fundamental prerequisite (e.g . tenacity, accuracy, concentration) in corresponding and managed workshops
b) coping social and for life practical situation with the help of socioterapeutu and psychotherapeutic

Image snug workshops is gradual, tzn. as though patients by kind his disturbances and well - kept capacity of work can be registered to the shopfloor, where's regime looser, exigencies on their efficiency lower and stopping time shorter than full time (it e.g . in the first year rehabilitative of the process).

Patients that the are less cursed with and have more well - kept capacity of work, can be registered to the shopfloor that the has already regime strap and longer stopping time (7 o'clock every day).
Best of those that the skirt snug workshops, they may count enlistment to the so - called study bullpen centre, where take into account year as far as year and a half present training, where already directly prepare to achievement definite occupation (8 o'clock every day). Here after one month's trial period that the be instrumental towards elaboration particular aims and acknowledges fitness inmate to training, roughly count 6- moon stay that the already gives participant possibility direct training in a certain activities. In surplus time then is given already independent job, to evidence progress in his social conformity contingent real service conditions.

Snug living, housing underprivileged community:

These forms interlock living to those inmates that the already have - not personal family or she nor unavoidable, or have - not self-contained home or cannot manage independent living. Again discusses various steps these arrangement with step by step waning measure assist in through social, event. medical workers.

Socioterapeuticke clubs:

Make possible inmates regular contact in the same way disabled inmates in informal environment with possibility usage of free time, common visitors sports and cultural action, common trips and social usage at all, whereby notably administer to to increasing their sociability, decrease social isolation thereby of course to increasing quality of life these disordered.

Co - operative insider ill and their related:

Smoothing - out common problems, support cohesion alike disabled, deal with cooperation with families inmates, with medical structures that the browse. Further they may participate also organization postgraduate courses in questions treatment, rehabilitation, re - - socialization disordered.




Standard specialty psychiatric care



Kind care
Limit on obyv. Survey ochre. Olomouc

Standard Skutec. 98

Stacionár.léèení
0,5 luz.//1000 obyv.
120
715

Daily clinic
1 place/7000 obyv.
33
15

Chr. living I
poling. supervision
1 place/4000 obyv.
56
4

Chr. living II
entire supervision
1 place/7500 obyv.
31
0

Chran. shopfloor
1 place/3500 obyv.
68
20

Long - term
rehabilitation
1 place/4100 obyv.
56
0

Centre for
sanity
1 period for 60
as far as 100 yew. obyv.
2,2
1

Ambulatory
psychiatrist
1 on 20.000 obyv.
11,25
14



Summary external and our experience ripen to close, that the future development in the area psychiatric care unswayed to disturbance psychiatric medical institution, but to restraint of the number of beds contemporary construction complementary services namely in proximity domicile psychiatric inmates. Further leads to developing ambulance special and practical doctors. Presumption positive general drift is entire change in thinking medics in terms of holistic medicine and team cooperation in medical of the process.

Modern alienism = alienism integrativni.
Occurrence mental disorders in population:

1) According to WHO in Europe heavy mental disorder 7%
venial mental disorder 20- 30%

2) 1x behind life flip - flops on psychiatrist every 4. man

3) In CSFR (1990) - 1/3 population either mental disorder suffers or
is less sturdy and unstable (then in danger d.p.)

4) elimination yourself at our place diminishes from r. 1970
In 60. years – CSSR in Europe on 3. place
88 – 89... – – CSFR on 10. – – 12. Place

5) Every 10. man is along his life subject
danger more difficult mental shock, conflict.




II. part 2. lecture

First aid (I.), , pressing construction sequence cases in alienism (II.), , Suicidalita (III.)

This section alienism deal with by all the diagnostic and therapeutic routes solving psychopathological processes (construction sequence cases), which on the instant or virtually be connected with jeopardy life disabled individual.
Decisive moment is here fast estimation weightings situation, resolution kind intervention, (whether medial science research or eventually Psycho - social) and her flexible expense fulfilment on optimal place.

To mastered acute states in alienism testify next policy:

and) Loiter away and testify calm and survey.

b) Take into account general situation disabled and take more to solving and involved men of his surroundings.

c) Is if certainty in diagnostic enlistment acute state, then use specific intervention.

d) Always investigate with jeopardy suicidem (S) and his relevance.

e) Near incursive or potencionalne incursive no underestimate possible to jeopardy medic (therapist).
f) Stress disabled, that the his case isn't rare, that the similar smoothing - out often (familiarly).

g) Sensitively opt for and send round to hospitalization.

Every 10. man be in each of member land WHO subject danger heavy mental shock, conflict that the is able to unreel in mental disorder or end in suicidal or other unusual act (rage). Such unfavourable development is able to hamper timely diagnosis mental malfunctioning grant instantaneous qualified assist in.
In our conditions smoothing - out these situation and issues in health field next arrangement:

1. Medical first aid station (LSPP), medical attendance practical doctor, specialist no psychiatrists.

2. Psychiatric ambulance, event. psychological consulting room.

3. Station phone psychiatric assist in (hot line – LD) and centre critical intervention.

A) Station phone assist in – hot line and trust that the establish from r. 1964 (psychiatric clinic Prague – MUDr. Plzak, 1965 – psychiatric clinic Brno – professional. Hadlik etc ..) and presently is them in uninterrupted running after 24 o'clock in CR over 20, in partial running more than 30. Work in them for - skill panel – psychiatrists, psychologists, caseworker and their basic imposition is contact client and in a way lead talk alleviate anxieties calling, achievement retirement his negative affects, judgment weightings calling and proposition next progress. Z detailed analyses talks behind 30 years tingle lines trust follow on, that the is coming how first psychiatric help, so and help social- health (problems interpersonal relations), , 10% talks concerned serious misconduct problems, when calling were in danger suicide.

B) Critical centre: exist at our place from r. 1989 (Psychiat. clinic Brno – professional. Plum, finally asylum Bohnice, psychiatric clinic Prague, in r. 1991 RIAPS – regional institute ambulatory Psycho - social services – Prague, in r. 1995 psychiatric clinic Olomouc – professional. Boucek). E.g . tingle centre has 10 beds, help provides how form ambulatory, so and short - term hospitalization (projection. 5,2 of the day). Within a year will visit arrangement at average 1.000 citizens, from nichz 1/3 is hospitalized. 60% clients is coming without recommendation, 40% advise practical physicians, ambulatory psychiatrists or line trust. This arrangement has its stand-by cost seat on system acute psychiatric- psychological and social assist in clients in crisis.

4. Period psychiatric intensive care and reception sick - bed
psychiatric detachment.


I. First help in alienism

First aid is necessitated often in a place of, where get to rise mental disturbances or undesirable health.Summon doctor must consider not only manifestation disabled, but also social situation (terms disabled to his nearest surroundings and iterrelations between involved persons) and decide, whether is intervention fit. Doctor here presents first special authority, before niz costs all catechism.

Is concerned psychotic?

Will conversation with disabled at preservation psychological access sufficient or it is necessary ordain Psycho - pharmacodynamic?

Which Psycho - pharmacodynamic and in what tax?

Requires if state treatment, be sufficient ambulatory psychiatrist or is necessary hospitalization?

Here first decision doctor be often crucial to whole next fate disabled!

Hits and intervention near disabled already in early period have no doubt preventative character, because not only obstruct and hold under development personal mental disturbances, but obstruct and consequences postneuritic crisis in wider surroundings disabled.


II. Pressing construction sequence cases in alienism

1. Construction sequence cases psychomotor fever (discomposure)
and) near organic causes
b) near schizophrenia, affectionate disorders and adjustment disorders:

• katatonni complex
• manilla complex
• depressive complex with agitovanosti

2. Construction sequence cases pair with disorder sense of

3. Paranoidne hallucinatory sy

4. Depressive sy, anguished and panicked state

5. Acute construction sequence cases at alcoholic or dope dependencies

6. Acute construction sequence cases due using Psycho - pharmacodynamic

7. elimination yourself

Ad. 1a) Erethism with organic cause

These they may conduct near every intoxication, eventually near organic cerebral disorder (especially disorders vascular near Psycho - geriatric inmates).
Therapeutically advises hand to butyrophenones, e.g . Haloperidol (5 mg and.m. or and.in.), even if can expect undesirable cardio - vascular effects. Near epilepsy without status epilate. Valium 20- 30 mg. i.v. faces to improvement. At status epilate. Advises phenyl - hydantoin infusion 250- 500 mg. Is if anamnestic some, that the erethism arose on the basis toxic influences (alcohol, sedation, hypnotics, psychoactive matters), have - not serve suppressor preparations like klomethiazol, levomepromazin or valium!
Contrary to that testify version butyrophenones like Haloperidolu, event. zuclopenthixol (Cisordinol ac.).
At intoxication needle with halucinosou (Horrortrip) serve valium (20 30 mg and.in.).

Repetition taxs – Haloperidol to the 50 mg/day, levomepromazin to the 300 mg/day, zuclopenthixol 50- 100 mg/day, valium to the 60 mg/day, Klomethiazol to the 10 mg/day. Near geriatric inmates is dosage lower.

Ad. 1b) Near schizophrenic states impassionedness are patients high unquiet (tight) and highly peevishs (incursive). Can be incurred disorders sensation with hallucinations, paralogickym thinking with delusions, deep disintegration personalities, autism, flatted emotivity and katatonnimi disorders.

Pacification discomposure does neurolipomatosis, basalnimi or incizivnimi, event. their combination (chlorpromazine, chlorprothixen, levomepromazin, haloperidol, zuclopenthixol) and superadd tranquillizers (klorazepat, lorazepam).

Katatonni complex except discomposure, rage and nepodrobivosti is able to disply manifest and stupor (with taciturnity and immovableness – catatonia), flexibility cerea (super - structure limbs), deprecation fare and liquids. Therefore is then important careful physical and work - up, modification exsiccation, inner environment and application benzodiazepinu with short by the instrumentality of (klonazepam, alprazolam, midazolam), neurolipomatosis (haloperidol, droperidol, triperidol).

Ad. 2b) Acute manilla complex displaies highly stilted, sometimes peevish mood, psychomotor discomposure, increased self - importance, megalomania delusions, logorheou with large stream thoughts and ideas, excess sexual, voyager, purchase aj., sleeplessness. Since is missing opinion disturbances, have to be racked individual under pressure hospitalized. Farmakologicky antipsychotics – haloperidol, levomepromazin, stools and lithium or valproat.

Ad. 3b) Near acutely depressive state gets off depressed mood with agitovanosti, anxiety, themselves - incrimination and autoakuzacnimi delusions involved in desperation as far as suicidalnimi thoughts. Treatment is combination, F and PS. Recommendeds higher dues tranquillizers with antidepressive effects – alprazolam, bromazepam, clorazepam, basal N – CLPT, levomepromazin, finally carry the hod AD clomipramin (citalopram with it, that the take into account entrance effect behind 10- 14 dni - infusion).

Erethism at mental overfreight, adjustment disorders can be connected with incursive or asocial behaviour – smoothing - out psychotherapeutic (behind pharmacological supports) benzodiazepiny (valium, oxazepam, bromazepam).

2. Construction sequence cases pair with disorder sense of

Disturbances sense of be part of master symptoms acutely organic contingent disorders, whereas conduct various steps quantitative disorders sense of like possession, somnolence, sopor and coma. In alienism qualitative disturbances sense of find near delirious complex, near organic amnestic complex and near swooning states.
Causes delirious states can be partly toxic (alcohol, pharmaceuticals, needle), partly heavy physical diseases or traumatogenic construction sequence cases (after operations, infections, injuries lbi and brain, at disorders material exchanges, blood - vessel and presbycardia. Advises haloperidol, Mel - platform (f. about. Buronil), , Tiaprid (f. about. Tiapridal) and. m.
Near organic amnestic state occur disorientation and disturbances vstipivosti. These appearances are most frequent near antique with blood - vessel cerebral, degenerative disorders or chronic toxic infliction of brain.
Always it is necessary internisticke freeze physical state, from Psycho - pharmacodynamic is advise Haloperidol, Tiaprid.

Swooning construction sequence cases are mostly near epileptical illness without seizure states (fine print mal- status). Directed valium
10- 20 mg i.v. or Clorazepam 2- 4 mg i.v.
Near attack. states (status psychomotor) advise phenytoiny.

3. Paranoidne hallucinatory complex

In terms of SCH disorders is able to make for acute emergency situation paranoid hallucinatory complex, at nemz conduct delusions vexation, interaction stranger, depersonalization and disturbances get self. Disabled is able to be under their owing to dangerous how to himself, so and surroundings.
Advise antipsychotics, no cotradict delusions!
(haloperidol, olanzapin, risperdal, quetiapin)

4. Depressive anguished construction sequence cases

Depression and anxiety can be contingents how specific mental disorders (depressive episodes, recurrent depression or anxiety), so and organic illness or responses situation.
Organic causes for depressive and anguished syndromes they may be fixed in all sorts of physical disorders (endocrinous, infectious). Farmakogenne can be depression developed antihypertensive agent, corticosteroid drugs, but also in terms of treatment neurolipomatosis. Organic cause finds near seizure disorder at degenerative cerebral illness or dependences. Near these organic contingent states costs to the fore ablation harmful substances and endeictic treatment.

Near depressive disorders in pressing alienism distinguishes essentially among attenuator and curious- canvassed form that the is able to flow into until so - called melancholy salt - spring, when often threatens suicidum. Especially at the beginning and at the end depressive phase used to be enhanced risk suicide. Near canvassed depressive symptomatology advises suppressor antidepressant drug (e.g . amitriptylin) or antipsychotics (levomepromazin).

Situation reactive symptomatology like reaction to higher load or in terms of disturbances conformity contradistinguishs from sorrow intensity and longitude continuation depressive symptoms. In psychiatric emergency situation advises psychotherapeutic lead and processing event. suicidalniho behaviour. Only seldom serve tranquilizers.

Near states phobia and panicked in terms of anguished disorders used to be psychiatrist mostly summoned internist after it, what was outcast organic cause. Patients complain on palpitation heart, giddiness, feelings on fainting and creeps. To acute treatment panicked pelt with is mostly mere present doctor and his some style decisive. In prescription tranquillizers advises definite reserve namely with reference to possible development dependencies, prefers psychotherapy.
5. Acute construction sequence cases at alcoholic or dope dependencies

Near acute states developed using or abuse psychotropic materials gets off usually considerable anxiety and fever. Therapeutic procuration governs eater material (drug), her quantity and time last enjoyment. Often walks at the same time about politoxikomanii.

A) Alcohol

Alcohol is able to implicate at one - shot enjoyment alcoholic intoxication, at long - term then alcoholic psychosis and at sudden break - in syndrome abstinence.
In light acute intoxication is advise strong black coffee. Near more difficult intoxication applies caffeine and nootropika (piracetam, centrofenoxin, pyritinol). Aggressiveness solve mechanical limitation, at big discomposure advises haloperidol.

Near alcoholic psychosis – Korsakovovy and Wernickeovy encephalopathy advise thiamine 100 mg at least 10x, high tax nootropik and endeictic treatment.
Syndrome abstinence after amputation alcohol occur
near 10- 15 % chronic drinkers at sudden bunk - up or vehement decrease alcohol. Includes characteristic appearances like coarse shake, nauzea and vomit, cefalgie, general weakness, anxiety, sleeplessness, vegetative appearances (sweat, tachycardia, hypersphyxia), iluse or hallucination, sometimes preliminary epileptical paroxysmus type high roller mal.
Stepped up syndrome abstinence proceeds soused delirium – give a name him jumps. Acts about grave condition imperilling life (5 10 % mortality). Advises verification vigorous function, aneurine, irrigatation, endeictic internal treatment (beta blockers, antibiotics, antipyretics), nootropika in high taxs (piracetam 200- 400 mg), further either benzodiazepiny p.about., oxazepam, lorazepam, alprazolam after 2- 4 o'clock, klorazepat and.m. or klomethizol (f.o . Heminevrin) in ration 3000- 12000 mg in caps event. in infusion 0,8 % solution behind severe verification health personnel (keeps light somnolence!). Treatment klomethiazolem hasn't exceed 2- 3 for weeks, setting - out slow (danger habit). Z atypical neurolipomatosis is advise tiaprid in ration 1200- 1800 mg.

B1) Near acute intoxication opiates be the centre triassic: coma, inhibition breathing and eye piece sizes spencer header.
Complications can be paralysis airways, pulmonary dropsy, epileptical seizures, encephalohepetitis and failure circulation.
Intoxication opiates requires high - powered treatment reservation breathing. Specific treatment consists presented by antidota Naloxonu. At odvykaci crust ordain sedative antipsychotics, event. antidepressive or acts in terms of reduction dues by the help of Metadonu.

B2) Near kanabisove intoxication rules mostly sympatikomimeticke fever that the marks next symptomology: mydriaza, tachycardia, hypertonia, hyperthermie and hyperglycemia. It will often sees and red conjunctiva, increased nasal secretion and staphyloedema. At strong anxiety advise antianxiety drug (oxazepam, alprazolam, valium), is- if psychotic symptomatology, will hand to haloperidol. Bunk - up kanabis unswayed to no bodily manifestations.

B3) After intoxication hallucinogens like LSD, mescalin or psylocybinem walks especially near so - called Horrortripu about psychiatric emergency situation. Here turns rausovy experience relatively quickly in psychotic productive symptomologies, so that is necessary treatment Psycho - pharmacodynamic namely either benzodiazepiny or haloperidolem. Bodily appearances at untaught no conduct.

B4) Intoxication psychostimulanciemi (e.g . black beauty) is characterized row psychotic symptoms like increasing vigilance, instinct, fever, anxiety, but also optical hallucinations and delusions, but also sympatikomimetickymi elements. Therapeutically certify sitting benzodiazepiny event. version butyrophenones. Near intoxication happy dust conduct except anxiety and erethism also delirious construction sequence cases auditory and tactile hallucinations. At untaught from psychostimulancii conduct uncharacteristic anguished or depressive construction sequence cases.

B5) Intoxication hypnotics and tranquilizers proceed analogous to alcoholic, can be disturbances sense of different steps, further inhibition breath, hyperthermie, hypotony and absentio of or weakening muscular reflexs. Abstinence syndromes after intoxications hypnotics and tranquilizers they may lead as far as delirious states and relatively frequent is also occurrence paroxyzmu high roller mal event. as far as status epileptical.

B6) Volatile matters (organic solvents – toluene ad.), which encroach inhaling, they may cause disturbances sense of with delirious symptomology. Further is attendant ataxia, dysarthrie and mydriaza.


6. Acute construction sequence cases at treatment Psycho - pharmacodynamic

Over the last 45 years was mature much Psycho - pharmacodynamic that the brought great progress to the whole confection. Is but evident, that the at treatment Psycho - pharmacodynamic is able to happen and to certain emergency states in terms of:

and) adverse effect (1. neurolipomatosis, 2. antidepressive)
b) overdosage eventually intoxication
c) cure interaction
d) fenomenu from bunk - up, to abstinence phenomenon
Ad and) At treatment neurolipomatosis (basal, incizivnimi) conduct near 40- 60% treated extrapyramidal undesirable effects namely either 1) early or 2) late.

Ad a1) Belongs to here pharmacological parkinsonoid, acute dyskineze and akatizie. Near pharmacological parkinsonoidu is concerned increasing muscular tension and limitation dynamics in terms of hypokinetic- hypertonic complex. Limbs are in patch - overhang possession, masked face, quiescent shake, dysarthria, walking about small short step and lowered synkinetic. Correction consists in decrease dues antipsychotics, confusion behind atypical antipsychotics and version antiparkinsonik (biperiden p.about., f.about. Akineton
2- 8 mg/day).

Acute dyskinezy occur already in beginning treatment incisivnimi neurolipomatosis and are characterized muscular spasmophemia, especially nuchal, facial and ophthalmogyric thews (e.g . spasmodic pitching motion head, splay feet mouth, turns eyes in post, tortikolis, protruze language, sometimes as far as opistotonus. Sometimes can be disabled and beef swallow and larynx, which leads to dysphagia and dyspnoeic weight down). At first occurrence they may inmate considerably terrify. Quickly respond to antiparkinsonika.

Akatizie displaies unrest that the step by step verge into motory discomposure (get nowhere fast, passage etc.). Correction achieve best benzodiazepiny (valium) or antihistamines (prometazin).

Ad b) Belongs to here tardivni (late) dyskineze (tardivni dystonia and tardivni akatizie – very thin).

Tardivni dyskineze:
St. makes itself felt abohm choreiformnimi and atetoidnimi movements arm, through his leg, body, contorted in face, rumination, reel etc ..).
Rise after to many-moon or perennial feed neurolipomatosis and or after his sudden termination.
Treatment is uneasy, antipsychotics in what lowest tax, plant out anticholinergic pharmaceuticals, not long ago antiparkinsonika.

Among complication treatment neurolipomatosis do arithmetics blood changes (granulocytopenie, thrombocytopenie, pancytopenia – watched only near clozapinu), cardio - vascular complication, hepatic damage, increased seizure readiness, oculocutaneous complex and neuroleptic malignant complex, which is a life threatening state characterized disorder sense of, tremor, rigid muscular, hyperthermii, vegetative appearances (tachycardia, increased TK, arrhytmia, sweat) and epileptical paroxysmem.
Undergo medical treatment amantidinem, bromokriptinem and dantrolenem (1 2 mg/1 kg yoke).

Ad a2) Anticholinergic complex is able to most often reveal at treatment tricyclic antidepressive (amitriptylin, imipramin, dosulepin) or neurolipomatosis (thioridazin, clozapin, oxyprothepin). Will recognize partly after peripheral manifestations (ruddiness mucous membrane, mydriazy, tachycardia, disturbances eye accommodation, decrease sweat, hazardous road retting, clothing peristalsis, arrhytmia heart), partly central manifestations (delirious construction sequence cases, hallucination, delusions, myoklonus, choreatoidni movements).

Recommended treatment: anticholinesterazove preparations like eserine (behind lasting monitoring vigorous function), at arrhytmia lidocain (1 2 mg and.m., repeat possible after 30 mine. as far as 2 o'clock).

Serotoninovy complex is toxic state incurred feed serotonergnich medicines in high taxs or in combination with inhibitors monoaminooxidazy (MAO). Among serotonergni pharmaceuticals line SSRI antidepressive (fluoxetin f.about. Prozac, Deprex, fluvoxamin f.about. Fevarin, citalopram f.about. Seropram, paroxetin f.about. Seroxate, sertralin f.about. Zoloft), from II. generation then klomipramin f.about. Hydiphen, Anafranil ad.
Typical appearances are discomposure, fuzziness, sweat, shake, hypertensive, hyperpyrexie, salivation, diarrhoeas and so on
Endeictic treatment, discontinue a drug, nonspecific enteramin antagonist (lisurid) or beta- blockers.

Ad b) Continue to be yet mostly used tymoprofylaktikem lithium. Since is small span among tax therapeutic and toxic, traces surface 1x monthly, to precede intoxication. Further advises trace water intake and salts, increased sweat and cure interaction (diuretic, analgetic, antarthritic etc ..). Lithiova intoxication begins dysarthria muscular clonus, shake, diarrhoeas, somnolence, muscular weakness, finally is able to appear as far as coma, epileptical seizures, choreatetoidni movements, nystagmus, hyperreflexie, arrhytmia as far as cardio - vascular collapse, abohm EEG.
Treatment: interrupt feed lithium, hydration inmate, aminophylline to repair secretion lithium from organism and alkalinization urine. Near heavy intoxication diureza manitolem or urea event. hemopefuze or hemodialyza.


Ad c) To cure interactions (among Psycho - pharmacodynamic) belongs to e.g . therapy irreversibilnich inhibitors monoaminooxydazy (IMAO) and tricyclic antidepressive, further SSRI and IMAO. As well feed IMAO and enjoyment groceries with high tyramine or noradrenergnimi pharmaceuticals (psychostimulancia, anorexic, antihypertensive agent etc ..). Is able to come to so - called hypertensive crisis that the displaies sudden increasing TK, cefalgii, palpitation, sweat, mydriazou, nauzeou as far as vomitus, but also to cerebral bleeding or and cardio - vascular failure. Hand to have to nifedipin (Corinfar) in tax 10 mg.

Ad d) Pressing construction sequence cases for reasons odvykacich after bunk - up Psycho - pharmacodynamic conduct especially after longer feed benzodiazepinu. Acts about vegetative symptoms as is sweat, shake, tachycardia and irregularity blood pressure. Another time they may offer epileptical seizures and psychotic disturbances. Benzodiazepiny it is necessary prick in step by step. Idem advises near antidepressive and neurolipomatosis, when are used for a longer time, not only therefore, he should could come to height featured vegetative symptoms, even but also to fault signature, for niz were to be pharmaceuticals hard - sets (depression, psychosis).



Tab. 4: Most often advise Psycho - pharmacodynamic in pressing alienism and their indication


I. ANTIPSYCHOTICS DESIGNATING AREAS

haloperidol 5- 50 mg/day construction sequence cases discomposure near organic
levomepromazin (Tisercin)100 300 mg/d. contingent disorders
chlorpromazine (Plegomazin)100 500 mg/d. (toxic, organelle. brains.
zuclopenthixol (Cisordinol Acutard) disorder),near schizofr.,
50 100 mg/day near affect. disorders (manilla
Mel - platform (Buronil) 50 400 mg/day sy, depressive sy with agi-
tiaprid (Tiapridal) 400 1800 mg/day tovanosti), abstinence sy (near needle, alcohol),
delirious sy, organic amnestic complex


II. ANTIDEPRESSIVE

amitriptylin 100- 150 mg/day anxiosne- depressive
dosulepin (Prothiaden 150- 300 mg/d. complex
clomipramin (Anafranil 75- 225 mg/d.
citalopram (Seropram) 20 40 mg/day


III. TRANQUILIZERS

valium 10- 60 mg/day construction sequence cases anxiety at
bromazepam (Lexaurin)5 15 mg/day depressions, disorders
alprazolam (Xanax, Neurol)1,5 6 mg/d. conformity, abstain.
klorazepat (Tranxilium)15 60 mg/day complex, panicked
oxazepam 30- 90 mg/day disorders, akatizii
klonazepam (Rivotril)1 8 mg/day
- status epileptical
klomethiazol (Heminevrin)3 12 g/d jumps


IV. OTHER PHARMACODYNAMIC

biperiden (Akineton)1 8 mg/day parkinsonoid
side effects neurolipomatosis


III. Suicidalita

7. In every acute psychiatric emergency situation would had think of at the question suicide, because her danger be no fear of only near depressive disorders, but also near schizophrenic psychosis and dope dependence.

Essential characteristic suicide (S) is voluntary intention finish life and purposeful bent act leadership deathly.
Viewegh (1996) defines S: Behind suicide mark such way car - destructive act that the clearly means intention individual optionally finish personal life and purposeful endeavour elect for this purpose resources, near nichz possible suppose, that the to extinction life will lead.
Near themselves - manslaughter is missing knowledgeable intention individual optionally die. Parasuicide (SP) supposes intention individual die, but nevertheless will stay on alive.
Near parasuicidia (demonstrative S) is absently longing hereafter, but after escape individual from seemingly unsolvable situation and event. necessitate other bearings surroundings to his person.

S classify into biicke and cap:

Near biickych S coming - out motive from property (balance sheet S), near cap S from abnormal psychology (1/3 finished S be in at persons ascertained mental disorder).
S be ranked among 10 most frequent cause of death.

Estimates , that the perhaps 10- 25 % suicides at our place follow on big affective disorders. According to retrospective psychiatric autopsy however it seems, that the affective disorders be in fact against a background 70- 80 % end one's life suicides. Features , that the perhaps
15- 20 % ill with diagnosis bipolar disturbances do away with oneself, which is roughly 30x higher occurrence suicidia than in common population. Great deal of surplus suicides evidently follow on of others mental disorders. Roughly 40 % suicides at our place has intended some psychiatric diagnosis. Only near less than 4 % suicides was positively intended, that the didn't have mental disorder.

Giant. 13.6 development elimination yourself on territory CR in 20. century. Data 1900 – 1965 be merely interproximate guessingly on the basis different sources. Only statistics last 30 years makes it possible to division into man and women and comparison in time.
In CR is of late years S below 20 on 100.000 obyv. /year.


Among stand with high selimination yourself (P > 25) belongs to Scandinavia, Switzerland, SRN, Austria, Hungary, Rumania (so - called suicidalni zone) and Japan.
On the contrary in Spain, Italy and Holland is P < p =" 24" p =" 15.">