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Isotretinoin INN (capsules, rectal suppositories)

International name: Isotretinoin

Dosage form: capsules, rectal suppositories

Pharmachologic effect:

The biologically active form of vitamin A can be synthesized in the body. Isotretinoin does not directly bind to nuclear retinoic acid receptors (RAR or RXR), as well as their subclasses (alpha, beta and gamma receptors). It quickly turns into tretinoin (trans-retinoic acid) and other substances-ligands of nuclear retinoic acid receptors and disrupts the expression of a gene that causes changes in protein synthesis (either induction or inhibition, depending on the state of the tissue). Reduces the number and production of sebaceous glands, resulting in a decrease in the content of Propionibacterium acnes (isotretinoin itself does not have an antibacterial effect). It has anti-inflammatory, keratolytic and antiseborrheic effects, inhibits the terminal differentiation of keratinocytes, stimulates regeneration processes.

Pharmacokinetics:

When taken orally, it is rapidly and fairly completely absorbed; ingestion with food increases absorption. After oral administration at a dose of 80 mg TCmax of isotretinoin – 3 hours, 4-oxo-isotretinoin – 6-20 hours; Cmax of isotretinoin – 256 ng / ml (98-535 ng / ml), 4-oxo-isotretinoin – 87-399 ng / ml. Communication with plasma proteins (mainly with albumin) – 99.9%. After oral administration at a dose of 40 mg 2 times a day, Css of isotretinoin is 160 + 19 ng / ml, 4-oxo-isotretinoin 6 hours after taking the same dose exceeds that of isotretinoin. Isotretinoin is found in many tissues of the body as early as 15 minutes after oral administration, reaches a maximum concentration after 1 hour and decreases to trace concentrations after 24 hours; in trace amounts found in the liver, uterus, ovaries, adrenal glands and lacrimal glands 7 days after application. Metabolized in the liver and intestinal wall with the formation of metabolites – 4-oxoisoretinoin (basic), tretinoin and 4-oxo-tretinoin. T1 / 2 of isotretinoin – 10-20 hours, labeled with radioisotopes of isotretinoin after oral administration at a dose of 80 mg – 90 days, 4-oxoisoretinoin – 25 hours (17-50 hours). It is excreted by the kidneys (65%) and with bile or feces (83%).

Indications:

Acne vulgaris of severe course (including with the formation of abscesses, hemorrhagic, confluent, prone to scarring and pigmentation disorders), resistant to conventional methods of therapy. Rosacea (severe course); folliculitis caused by gram-negative microorganisms; purulent hidradenitis (auxiliary treatment). Violation of keratinization (including ichthyosis, follicular keratosis, palmar-plantar keratoderma, red hairy pityriasis).

Contraindications:

Hypersensitivity, pregnancy established and planned (possibly teratogenic and embryotoxic effects); lactation period; hypervitaminosis A. For rectal use – diseases of the rectum. C with caution. Conditions causing hypertriglyceridemia (including a history of familial hypertriglyceridemia, alcoholism, obesity, diabetes mellitus – isotretinoin increases plasma triglyceride concentrations, lowers HDL and increases the risk of cardiovascular disease), liver and / or kidney failure, chronic pancreatitis, liver and / or kidney failure, CHF, diabetes mellitus and predisposition to its development.

Dosing regimen:

Inside, during meals. With acne vulgaris – at a daily dose of 0.5 mg / kg in one or more doses for 2-4 weeks; then the dose is increased to 1 mg/kg and treatment is continued for another 12-20 weeks; the maximum daily dose is 2 mg/kg. Dose adjustment is carried out depending on the sensitivity to the drug and / or the severity of side effects. A noticeable therapeutic effect is usually observed after 1-2 months of treatment, sometimes it may take 4-5 months to achieve clinical remission. If the number of rashes has decreased by 70% or more in 15-20 weeks, treatment is stopped. The general course dose in most cases does not exceed 100-150 mg/kg. If a persistent or recurrent course of the disease is confirmed, a break of at least 8 weeks should be taken before re-treatment (depending on individual sensitivity, up to 16-20 weeks). In the event of an exacerbation of the disease at the beginning of treatment, you should switch to lower doses of the drug – 0.5 mg / kg (or lower) for 2 weeks. With folliculitis caused by gram-negative microorganisms, rosacea, purulent hydradenitis – at a daily dose of 0.5-1 mg / kg for 4 months. In violation of keratinization – up to 4 mg / kg / day (depending on the disease and severity of the course), the duration of treatment is up to 4 months. After achieving clinical remission, the lowest possible dose should be used. Rectally, 0.5-1 mg / kg 1 time per day, at night. The course of treatment is 8-12 weeks. Intervals between repeated courses – 1-2 months.

Side effects:

On the part of the skin: itching, photosensitivity, peeling of the skin of the palms and soles, thinning of the hair; rarely – cheilitis, skin infections, skin rash. From the senses: xerophthalmia, burning in the eyes, conjunctival hyperemia, difficulty wearing contact lenses; rarely – cataract; with prolonged use in high doses – a violation of the clarity of visual perception, a violation of twilight vision, optic neuritis. From the musculoskeletal system: arthralgia; with prolonged use in high doses – hyperostosis. From the nervous system: headache, excessive fatigue; rarely – depression, psychosis, suicidal thoughts, pseudotumor of the brain (violation of the clarity of visual perception, headache, intractable nausea and vomiting). From the digestive system: dyspepsia, dryness of the oral mucosa, bleeding from the gums, inflammation of the gums; rarely – hepatitis, colitis, regional ileitis. Laboratory indicators: increase in the concentration of TG, cholesterol, decrease in plasma HDL. Local reactions: when the suppository mass flows out – a local irritating effect (keep the “lying” position for 30 minutes after the suppository is inserted). Teratogenic and embryotoxic effects: congenital deformities – hydro- and microcephaly, underdevelopment of the cranial nerves, microphthalmia, malformations of the CCC, parathyroid glands, skeletal disorders – underdevelopment of the digital phalanges, skull, cervical vertebrae, femur, ankles, bones of the forearm, facial skulls, cleft palate, low location of the auricles, underdevelopment of the auricles, underdevelopment or complete absence of the external auditory canal, hernia of the brain and spinal cord, bone fusion, fusion of the fingers and toes, impaired development of the thymus gland; fetal death in the perinatal period, premature birth, miscarriage), premature closure of the epiphyseal growth zones; in an animal experiment – pheochromocytoma. Other: epistaxis, dryness of the nasal mucosa.

Special instructions:

During treatment, liver function, lipid content in blood serum (on an empty stomach) should be monitored. It should not be prescribed for mild to moderate acne vulgaris. Patients with diabetes are advised to conduct more frequent monitoring of blood glucose levels. Patients wearing contact lenses, in case of side effects from the eyes, should use glasses. During the period of treatment and within 30 days after its completion, it is necessary to completely exclude blood sampling from potential donors to completely exclude the possibility of this blood getting into pregnant patients (high risk of developing teratogenic and embryotoxic effects). Women of reproductive age should use reliable contraceptive drugs 4 weeks before, during and for 1 month after the end of treatment. If pregnancy occurs, it should be terminated for medical reasons. It is necessary to avoid increased insolation, incl. UV therapy. In the event of colitis, visual disturbances and symptoms of a pseudotumor of the brain, treatment is stopped. If a brain pseudotumor is suspected, a neurological examination is performed. During the period of treatment, care must be taken when driving vehicles and engaging in other potentially hazardous activities that require an increased concentration of attention and speed of psychomotor reactions (when taking the first dose).

Interaction:

Antibiotics of the tetracycline series, GCS reduce the effectiveness. Simultaneous use with drugs that increase photosensitivity (including sulfonamides, tetracyclines, thiazide diuretics) increases the risk of sunburn. Simultaneous use with other retinoids (including acitretin, tretinoin, retinol, tazarotene, adapalene) increases the risk of hypervitaminosis A. Tetracyclines (including minocycline) increase the risk of increased intracranial pressure (simultaneous use with isotretinoin is not recommended) .

Hebephrenic form of schizophrenia is the most malignant, occurs at an early age in adolescents or in adolescence.

Typical symptoms of the manifestation of the disease: ridiculous foolish behavior and excitement, accompanied by inadequate emotional actions. Patients laugh loudly, grimace, somersault, sing and laugh. In dealing with people, they engage in absurd reasoning on any occasion, depicting intricate bows, squats and poses. They can speak in a whisper, in a bass voice, in a high voice, while their statements are ridiculous, the tone of voice is from calm to defiant. Sometimes you can observe an empty euphoria, inadequate crying, and with an emotional-volitional disorder, dementia.

The disease often begins to develop with the appearance of increased anger, irritability. Speech loses its consistency, often there is cynical abuse in communication. Behavior includes purposeful activity combined with negativism and stubbornness. Often there are patients with delusional ideas, accompanied by hallucinations.

The prognosis for hebephrenic schizophrenia has an unfavorable formation of personality defects. Social behavior is characterized by conflict and the inability to maintain interpersonal communication in the team and family. The development of the disease leads to a drop in activity, passivity and indifference. The disease occurs mainly in adolescence, adolescence, and in the future has negative consequences, as a rule, patients after the onset of the disease very quickly become disabled .

A fairly common occurrence among people who drink alcohol is a depressive state. Depression in alcoholism is an extremely impartial condition.

Why, after drinking a large amount of alcohol, does a person become more depressed, despite the fact that most people are convinced that drinking alcohol is one of the ways to relax and relieve emotional stress?

From the point of view of science, any alcohol-containing drinks are strong provocateurs of mental illness. They cause a state of euphoria, which, however, does not last long. After a certain time, the depressive state progresses. There is a direct relationship between alcoholism and disorders that are depressive in nature: a depressive state also contributes to the aggravation of alcohol dependence, just as long-term use of alcohol contributes to anxiety, melancholic and manic states.

The consequences of alcohol depression include:

– The appearance of thoughts of suicide. Suicide attempts are also not uncommon;
– Possible accidents, injuries caused by negligence; – Committing acts that pose a danger to society; – The transition of alcoholism to a chronic form; – Personal degradation of a person; – Alcoholic encephalopathy; – Epileptic psychosis occurs caused by alcohol consumption.

Varieties of alcoholic depression

Conventionally, there are two types of alcoholic depression:

1. Disorder after excessive alcohol consumption, which is of a short-term nature;
2. Severe depression after a long binge.

Treatment for alcoholic depression

The biggest difficulty in conducting and selecting a treatment regimen is that people in general do not understand that depression is a consequence of alcohol use, and not its cause. In this situation, treatment of alcohol dependence is necessary. Without medical assistance , it is not possible to remove the depressive state caused by alcohol addiction.

In modern medicine, the treatment of alcoholic depression involves a personal approach to each patient. The complex of treatment itself consists of:

– Reception of special medicines;
– Carrying out psychotherapeutic sessions; – Carrying out physiotherapeutic procedures.

If you need anonymous treatment for alcoholic depression, please contact our clinic. It is advisable not to delay contacting specialists, because delay can lead to extremely negative consequences.

Schizophrenia is a disease that results in disturbances in thought processes and provokes the “destruction” of emotions as such. It is impossible to completely get rid of schizophrenia (but history knows exceptions). But to achieve sustainable remission rates is quite realistic. In addition, modern methods of diagnosis and treatment allow a person with schizophrenia to return to the former indicators of activity, both social and emotional. One of the progressive methods is the treatment of schizophrenia with neuroleptics.

Stages of treatment for schizophrenia

Treatment of this disease is carried out in three main stages:

– Stopping . This stage involves the fight against delirium, catatonia, hallucinations and hebephrenia. The main goal of such treatment is to minimize psychosis.
– Stabilizing . It is a kind of continuation of the above phase of treatment. The main tasks are to consolidate the results that were obtained above.
– Maintenance therapy for schizophrenia. The main task is to maintain the psyche in a normal state and to delay psychosis as much as possible.

Treatment options for schizophrenia

All methods of treating the disease (including sluggish schizophrenia) can be divided into two main types: biological and psychosocial.

Treatment of schizophrenia, calling a psychiatrist in Moscow with a psychosocial method will not give you an instant result, but it will help to fix the positive effects of biological treatment. This prolongs the remission and the person gets the opportunity to be a full-fledged member of society. In addition, another positive aspect of the application of this method is the ability to reduce the number of drugs used in drug treatment. A person becomes able to control himself and his behavior, state.

Drug treatment is also used. They have certain effects on the brain. This method of treatment is the most effective, as it helps to prevent violations of the will, emotions and memory. With medication, it is possible to stop the process of personality destruction.

Schizophrenia therapy and antipsychotics in schizophrenia can stop the process of personality deformation. The latter option is used for productive schizophrenia, which can lead to hallucinations, impaired speech, memory and will. These drugs are used not only for psychosis, but also as prophylactic agents.

The notion that schizophrenia is a rare disease is erroneous. Mental illnesses are very common. That is why the development of modern methods of treatment and drugs plays such an important role: it is possible to reduce the suffering of the patient, his relatives, and also help the person return to a full life.

Drugs for the treatment of schizophrenia

Azaleptin has been treated since the 80s of the 20th century. Despite the prescription of use, today this drug is the most powerful antipsychotic – it is characterized by the highest rates of antipsychotic activity. In this parameter, the drug surpasses many others.

The effectiveness of the drug has been proven by 15 different clinical studies. For example, Azaleptin was compared with a foreign analogue. Testing was carried out by two main methods: alternating the use of drugs in one group of patients or parallel use of drugs in two different groups with similar symptoms.

Azaleptin is no less effective for affective -delusional disorders, hallucinatory-delusional, delusional than the most modern antipsychotics and Leponex – the original analogue of the drug has an identical spectrum of effects, as well as a similar specificity of side effects.

It is used not only in the treatment of schizophrenia, but also in the development of certain addictions. For example, with alcoholism. Also, patients with delusional disorders, as well as mood disorders, are subject to treatment with this method.

What neuroleptics are the most modern?

Clozapine treatment involves a very low risk of formation and further development of extrapyramidal disorders. Tardive dyskinesia also does not appear. This drug can (and should!) be used when it comes to the development of tardive dysinesia , which can be triggered by the use of other drugs.

Danilov conducted a number of studies related to the use of this tool. As a result: it is taken to assert that the use of the drug is safer than it was previously believed.

Treatment of schizophrenia with antipsychotics and the use of the aforementioned drug: the use of the latter is in no way inferior to the use of other modern methods of treatment. Some also note the “superiority” – the risk of neuroleptic malignant syndrome is excluded.

Schizophrenia is a fairly common mental illness. It is manifested by violations of thinking, perception, emotional-volitional disorders and inappropriate behavior. The term “schizophrenia” was proposed by the Swiss psychopathologist E. Bleiler . Literally, it means “splitting of the mind” (from the ancient Greek words “ σχίζω ” – I split and “ φρήν ” – reason, mind).

Historical background on schizophrenia

The first information about schizophrenia-like symptoms dates back to 2000 BC. Periodically, many eminent physicians of various eras have also described similar psychotic disorders. In his work The Medical Canon, Avicenna spoke of severe insanity, somewhat reminiscent of schizophrenia. Pathology began to be studied in more detail only at the end of the 19th century. The German psychiatrist E. Kraepelin (1856-1926) observed adolescent patients suffering from various psychoses. In the process of research, he found that after some time all patients developed a similar state of special dementia. It has been called “dementia praecox” ( dementia praecox ). Other psychiatrists have added to and expanded on the symptoms, course, and outcomes of this illness. At the beginning of the 20th century, the Swiss psychopathologist E. Bleiler proposed introducing a new name for the disease – “schizophrenia”. He proved that pathology occurs not only at a young age, but also in adulthood. Its characteristic feature is not dementia, but “violation of the unity” of the psyche. The proposed concept of schizophrenia was recognized by all psychiatrists.

Why does schizophrenia develop?

Despite the high level of development of modern medicine, it has not yet been possible to establish the exact cause of this disease. Psychiatrists are more inclined to the genetic theory of the occurrence of schizophrenia. It says: if there is a patient with schizophrenia in the family, then his blood relatives are at high risk of developing this pathology. However, the type of inheritance and the molecular genetic basis of the disease are unknown. An important role in the development of schizophrenia is played by personality traits, low social status (poverty, poor living conditions, a dysfunctional family, etc.), various diseases (drug addiction, alcoholism, chronic somatic pathologies, traumatic brain injuries, protracted psychotraumatic situations, etc.) Sometimes The onset of schizophrenia is preceded by stressful events, but most patients develop schizophrenia “spontaneously”.

Typical forms of the disease

Typical forms of schizophrenia include paranoid, hebephrenic, catatonic and simple forms.

Paranoid form (F20.0)

Most often in their practice, psychiatrists encounter a paranoid form of schizophrenia. In addition to the main signs of schizophrenia (impaired coherence of thinking, autism, decreased emotions and their inadequacy), delusions predominate in the clinical picture of this form. It typically manifests as persecutory delusions without hallucinations, grandeur delusions, or influence delusions. There may be signs of mental automatism, when patients believe that someone from the outside influences their own thoughts and actions.

Hebephrenic form (F20.1)

The most malignant form of schizophrenia is hebephrenic. This form is characterized by manifestations of childishness and foolish, ridiculous excitement. Patients make faces, can laugh for no reason, and then suddenly become indignant, show aggression and destroy everything in their path. Their speech is inconsistent, saturated with repetitions and invented words, very often accompanied by cynical abuse. The disease usually begins in adolescence (12-15 years) and progresses rapidly.

Catatonic form (F20.2)

In the clinical picture of the catatonic form of schizophrenia, motor function disorders predominate. Patients for a long period of time are in an unnatural and often uncomfortable position, without feeling tired. They refuse to follow instructions, do not answer questions, although they understand the words and commands of the interlocutor. Immobility in some cases (catalepsy, a symptom of “mental (air) cushion”) is replaced by attacks of catatonic excitement and impulsive actions. In addition, patients can copy facial expressions, movements and statements of the interlocutor.

Simple form (F20.6)

For a simple form of schizophrenia, an increase in exclusively negative symptoms, in particular, apathico-abulic syndrome, is characteristic. It is manifested by emotional poverty, indifference to the world around, indifference to oneself, lack of initiative, inactivity and rapidly growing isolation from people around. At first, a person refuses to study or work, breaks off relations with relatives and friends, wanders. Then, gradually, the accumulated baggage of knowledge is lost and “schizophrenic dementia” develops.

Atypical forms of the disease

In the clinic of atypical forms of schizophrenia, non-standard, not quite characteristic signs predominate. Atypical forms include schizoaffective psychosis, schizotypal disorder ( neurosis-like and variant), febrile schizophrenia, and some other forms of schizophrenia.

Schizoaffective psychosis (F 25)

Schizoaffective psychosis is a special condition that is characterized by the paroxysmal occurrence of schizophrenic (delusional, hallucinatory) and affective symptoms (manic, depressive and mixed). These symptoms develop during the same attack. At the same time, the clinical picture of the attack does not meet either the criteria for manic-depressive psychosis or the criteria for schizophrenia.

Schizotypal disorder ( neurosis-like variant) (F 21)

The neurosis -like variant of schizotypal disorder is manifested by asthenic, hysterical symptoms or obsessive phenomena that resemble the clinic of the corresponding neuroses. However, neurosis is a psychogenic reaction to a traumatic situation. A schizotypal disorder is a disease that occurs spontaneously and does not correspond to the existing frustrating experiences. In other words, it is not a response to a stressful situation and is characterized by absurdity, deliberateness, as well as isolation from reality.

Febrile schizophrenia

In extremely rare cases, there are acute psychotic states with signs of severe toxicosis, called febrile schizophrenia. Patients have a high temperature, symptoms of somatic disorders (subcutaneous and intraorganic hemorrhages, dehydration, tachycardia, etc.) are increasing . Patients are confused, rush about in bed, make senseless movements, cannot say who they are and where they are. Febrile schizophrenia should be distinguished from neuroleptic malignant syndrome. This is a fairly rare life-threatening disorder associated with the use of psychotropic drugs, most often neuroleptics. Malignant neuroleptic syndrome is manifested, as a rule, by muscle rigidity, fever, vegetative changes and various mental disorders.

Rare forms of delusional psychosis

Rare forms of delusional psychoses include chronic delusional disorders (paranoia, late paraphrenia , etc.), acute transient psychoses.

Chronic delusional disorders (F22)

This group of psychoses includes various disorders in which chronic delusions are the only or most prominent clinical feature. Delusional disorders observed in patients cannot be classified as schizophrenic, organic or affective. It is likely that the causes of their occurrence are genetic predisposition, personality traits, life circumstances and other factors. Chronic delusional disorders include paranoia, tardive paraphrenia , paranoid psychosis, and paranoid schizophrenia with sensitive relationship delusions.

Paranoia (F22.0)

Patients suffering from paranoia are often suspicious, touchy, jealous. They tend to see the intrigues of ill-wishers in random events, remember grievances for a long time, do not perceive criticism, and treat people around them with acute distrust. They often have overvalued delusions of grandeur and/or persecution, on the basis of which patients are able to build complex logical conspiracy theories directed against themselves. Often, those suffering from paranoia write a huge number of complaints against imaginary ill-wishers to various authorities, and also start lawsuits.

Acute transient psychoses (F23)

The clinic of acute transient psychosis develops after a fleeting period of confusion, anxiety, restlessness and insomnia. Psychosis is characterized by the appearance of acute sensory delusions with rapid changes in its structure. Most often, there are delusions of influence, persecution, relationships, staging, false recognitions and delusions of a double. Hallucinatory experiences, true auditory and pseudohallucinations are possible. As a rule, they are unstable and tend to quickly change each other.

Types of schizophrenia and prognosis

There are three types of the course of schizophrenia: continuous, periodic ( recurrent ) and paroxysmal- progressive (coat-like).

Continuous schizophrenia

This type of schizophrenia is characterized by steadily progressive dynamics. Depending on the degree of its progression , a malignant, moderately progressive and sluggish course is distinguished. With a continuous course, there are periods of exacerbation of the symptoms of schizophrenia and their relief. However, full-fledged qualitative remissions are not observed. The clinical and social prognosis in the majority of such patients is unfavorable. The vast majority of patients undergo inpatient treatment or stay in neuropsychiatric boarding schools. All of them sooner or later receive the first group of disability. In some patients, after many years from the onset of the disease, clinical manifestations are somewhat reduced and due to this they are kept at home, remaining unable to work.

Periodic ( recurrent ) schizophrenia

With this type of schizophrenia, attacks of productive mental disorders occur periodically and are not accompanied by profound personality changes. Their number is different. Some have one attack in their entire life, others have several, and still others have more than ten. Attacks of schizophrenia can last from a few days to several months. They are of the same type (similar to each other) or heterogeneous (dissimilar to each other). The medical and social prognosis for intermittent schizophrenia is generally quite favorable. This is due to the insignificant severity of negative personality changes or their absence due to persistent intermission or practical recovery. The prognosis worsens with worsening, lengthening and more frequent attacks of recurrent schizophrenia.

Paroxysmal progressive schizophrenia

The most common paroxysmal -progressive course of schizophrenia. This variant of the course is characterized by the presence of episodic attacks of schizophrenia with inferior low-quality remissions. Each attack leads to a personality defect, as well as an increase in delusions and hallucinations. The degree of progression of fur-like schizophrenia and the depth of the mental defect may vary. The clinical and social prognosis of this type of schizophrenia course is determined by the rate of increase in personality changes, as well as the duration, frequency and severity of attacks. An unfavorable prognosis has a fur-like schizophrenia with a rapidly emerging mental defect. Relatively favorable prognosis for sluggish coat-like schizophrenia. It is characterized by the rare occurrence of seizures that are non -psychotic in nature. The rest of the cases are at intermediate levels between these extreme options.

Differential diagnosis of schizophrenia

The diagnosis of schizophrenia is established after the duration of the disease has exceeded six months. In this case, there must be a significant violation of social adaptation or disability. At its core, schizophrenia is a diagnosis of exclusion. To establish it, it is necessary to exclude affective disorders, alcoholism and drug addiction, which could lead to the development of psychopathological symptoms. Huge difficulties arise in the differential diagnosis of catatonic and paranoid forms of schizophrenia from the corresponding forms of somatogenic, infectious, toxic, traumatic and other exogenous psychoses during their long course. The basis for the construction of the diagnosis is specific clinical manifestations: emotional dullness, disturbances in the harmony of thinking and volitional disorders.

Suicidal behavior in patients with schizophrenia

The term “suicidal behavior” refers to a conscious action that is aimed at voluntarily depriving oneself of one’s life. In schizophrenia, one can speak about it only if the suicidal person is aware of his actions (does not stay in a psychotic state, and also does not have pronounced personality defects). In other cases, such behavior is considered auto-aggressive .

According to statistics, about half of patients with schizophrenia have attempted suicide over a twenty-year period of the disease. Of these, 10% were completed. Suicidal behavior is a direct indication for seeking psychiatric advice. And the best option is to hospitalize the suicide in a psychiatric hospital.

Treatment of schizophrenia

The vast majority of people with schizophrenia need qualified help in a psychiatric hospital. Hospitalization allows for constant monitoring of the patient, capturing minimal changes in his condition. At the same time, the clinical manifestations of the disease are detailed, additional studies are carried out, and psychological tests are performed.

Despite advances in modern medicine, there is no way to completely cure schizophrenia. However, the methods of therapy used today can significantly alleviate the patient’s condition, reduce the number of relapses of the disease and almost completely restore his social and daily functioning. Psychopharmacotherapy plays a major role in the treatment of schizophrenia . For this purpose, three groups of psychotropic drugs are used: antipsychotics, antidepressants and tranquilizers. They are used for a long time (from a week to several years, up to a life-long intake). It is important to remember that the sooner treatment for schizophrenia is started, the better the prognosis awaits the patient.

Treatment with psychotropic drugs

Antipsychotic therapy is indicated in the presence of an acute condition. The choice of drug depends on the clinical symptoms of an attack (exacerbation). In the case of dominance of psychomotor agitation, hostility, aggressiveness, neuroleptics are used, which have a predominant sedative effect ( tizercin , chlorpromazine , chlorprothixene ). If hallucinatory-paranoid symptoms predominate, “powerful” typical antipsychotics are prescribed that are able to fight them (haloperidol, trifluoperazine ). The polymorphism of clinical symptoms requires the use of typical antipsychotics with a broad antipsychotic effect ( mazheptil or piportil ). Sluggish schizophrenia is treated with low to moderate doses of antipsychotics and antidepressants. In the case of sluggish schizophrenia, accompanied by phobias and obsessions , sedative tranquilizers ( relanium , phenazepam, alprazolam, lorazepam ) are used.

Dealing with the side effects of antipsychotics

Prolonged use of antipsychotics very often leads to their drug intolerance. It manifests itself by side effects from the nervous system and the development of complications ( tardive dyskinesia and neurolepsy ). In such situations, antipsychotics are prescribed that do not cause or practically do not cause unwanted neurological symptoms ( leponex , ziprexa , rispolept ). In the event of dyskinesia , antiparkinsonian drugs ( akineton , napam , cyclodol, etc.) are included in the therapy . If depressive disorders appear, antidepressants are used ( reksetin , anafranil , lyudiomil , amitriptyline, etc.). You should know that all appointments are made and corrected by the doctor. Spontaneous withdrawal of drugs is prohibited. This carries a high risk of relapse.

Other treatments for schizophrenia

To date, electroconvulsive therapy (ECT), insulin coma and atropinocoma therapy remain relevant. They are not considered as first-line treatments, but they can be used when other methods are ineffective. Psychotherapy, family therapy, art therapy and other methods are aimed at social and professional rehabilitation.

Social rehabilitation

Social rehabilitation is indicated for almost all patients suffering from schizophrenia, with the exception of patients in whom the ability to work is preserved and social adaptation has an appropriate level. Even in severe cases, a number of patients partially recover basic self-care skills. After a multi-stage social rehabilitation, they can be involved in simple labor activities.

Advice for the family of a person with schizophrenia

Schizophrenia is a serious illness, both for the person himself and for his close circle. However, if a person is not able to understand that he is sick, the family is simply obliged to recognize the disease and seek help from a psychiatrist. It is time to dispel the existing stereotypes that it is impossible to help a patient with schizophrenia. Maybe. With properly selected therapy, long-term high-quality remissions are achieved with full recovery of working capacity over a long period of time. The main thing is to recognize the disease in time and start treatment. If this is not done, the person, as a rule, is waiting for emergency hospitalization already in a state of psychosis. Don’t wait until the worst happens to take action. Relatives are the only people who can change the life of a schizophrenic patient for the better. The quality of life of patients suffering from this disease largely depends on their support and their participation in the recovery process. If you suspect that someone close to you has schizophrenia, contact a psychiatrist immediately.

A relatively young direction in working with the subconscious and inner feelings of a person. The author of this direction is the psychologist and coach Pavel Piskarev. Its main feature is the transfer of emotions and feelings through paper, expressing all sensations through geometric shapes. Neurographics perfectly combines drawing and already proven methods: psychosynthesis and gestalt psychology.

Subtleties and basic patterns of neurographic session

The main patterns of neurographics are built very simply. Thanks to the drawing, a person uses his neural connections, which allows him to convey his problems, feelings and even life strategies through it. For example, making the corners in the figures less sharp, as if rounding them, a person tries to mitigate the conflict, minimize negative emotions.

At the neurographic session, you can use the following figures:

– circle – an element that symbolizes positive, security and harmony,

– square – a state of reliability and strength, the ability to organize and attract, but on the other hand, it is conservatism that needs to be traced and defined correctly,

– triangle – an element that confirms an active life position and purposefulness, but at the same time, aggressiveness is possible.

A neurographic session allows you to learn how to smooth out certain moments, build a sequence of events that will allow you to develop correctly and at the same time not harm the emotional state of a person.

neurographic session at first glance is a creative process, but at the same time, it has its own rules. Their observance is necessary to achieve the goal.

1. Concentration of attention on the task. Extraneous conversations, thoughts and any distractions must be neutralized . You need to immerse yourself in the process of drawing, this will enable the specialist to quickly identify the source of anxiety and confusion.

2. Openness and sincerity. It is these two qualities that make the work effective and achieve positive dynamics.

3. Don’t chase instant results. Don’t focus on the result. You need to focus it on drawing and enjoy it, without pursuing other goals. It is this approach that will allow you to get the highest quality result.

Positive and negative aspects of neurographics

Neurographics is a young direction in psychology, which very quickly gained confidence and became in demand. It allows you to find ways to solve many problems.

The main positive features include:

– simplicity – you do not need to have special drawing skills to create elementary shapes.

– accessibility – neurographic sessions can be carried out anywhere and with the simplest available tools: crayons. Paints, markers.

– the ability to switch – in the process of drawing, neural connections are involved, which help to relax and disconnect from real problems and troubles.

– entry into a resource state – as a result of the work, you can quickly trace and focus on sharp corners, find a compromise and a solution.

– speed – neurographics with the right approach in 3-4 hours helps to work out the main points of a person’s request.

The negative aspects of neurographics include:

– the importance of an accurate interpretation of what is drawn. A detailed study of this direction in psychology helps to correctly solve the problem,

– the inability to work out deep shocks and old pockets of problems. Neurographics helps to cope with such traumas as: anger, anger, anxiety or confusion.

Neurographics is an excellent method for solving psychological problems, leveling the emotional state and dealing with negative emotions.

The concept of harassment appeared in our everyday life in 2017. An imported word, without which today it is practically indispensable.

Formally, this is a term that refers to any action that allows you to offend and injure a person. Often this term is used in the sense of harassment.

Features and causes of the manifestation of harassment

The reasons for the manifestation of harassment are simple and natural. Men like women, and women need masculine strength and protection. At the moment when a woman is in a dependent state on a man, namely, a working or business relationship, and harassment is possible . To restrain a man from such a state can only be his own moral principles. If there are no such principles, then harassment occurs immediately. This not only hurts the opposite sex, but also creates psychological trauma for him.

The main reason for the manifestation of harassment is the lack of any regulatory framework and moral principles. The legislation of most countries simply does not provide for punishment for such actions. How to fight and resist this depends only on the other side and the specific circumstances in which it finds itself. The only thing you definitely shouldn’t do is endure and take it for granted.

How to deal with and resist harassment

Under the circumstances, the fight against harassment is solely the problem of the injured party. With this approach, it is important to understand that it is better to direct all your efforts to the prevention of such actions. As practice and statistics show, to cope with manifestations of harassment , you can use the following techniques:

1. Be specific and unambiguous in words and actions. This is necessary in order to avoid any misunderstandings .

2. Stick to the sequence. If you do not intend to reciprocate, do not accept courtship, nullify any unpleasant and incomprehensible situations of intimacy.

3. Be restrained and polite. Everyone has a very different level of tolerance, as well as the limits of what is acceptable. Therefore, it is very important to culturally and discreetly explain all your wishes. Be frank, if you do not like the situation, say so, do not smile and pretend that everything is fine.

4. Get rid of feelings of envy. Don’t be jealous of a friend who successfully married her boss. Envy is a terrible feeling, and the desire to get a job at someone else’s expense for many men is a great call to action.

5. Raise your skill level. A valuable specialist who makes a profit does not allow thoughts about the possibility of informal relationships. Men are afraid of strong women, so a confident and competent employee is simply too tough for harassment .

6. Do not stand on ceremony and speak directly. Direct displeasure is much better than a smile in response to a clear injustice.

In any case, do not lose heart and despair. It is despair that very often serves as the last impetus to the action of harassment . If you are unable to cope with the aggressivity of the opposite side on your own, try to involve outsiders in order to stop the desire a little, and reduce the number of opportunities. Only active opposition and direct statements in response to immoral actions help to cope with such people. But at the same time, it is very important not to use aggression, which can become an urge and impetus for illegal actions.

Compliance with minimum ethical measures in working relationships allows you to prevent and stop the manifestation of harassment.

In the modern world, the expression ” megalomania ” is used quite often, which implies an unfriendly attitude towards inflated self-esteem and narcissism of oneself .

There were times when delusional thoughts or ideas were designated by mania , but the main definition refers to an inflated self-esteem of oneself. From a medical point of view, such a phenomenon must be suppressed and neutralized at the stage of its early manifestation, otherwise it is already a psychological disorder.

The scale and types of crazy ideas

A crazy idea is equivalent to a false judgment, which has the following characteristics:

– delirium that occurs against the background of the disease,

– extreme definition of its significance,

– undeniable ideas and actions.

Against the background of various forms of manifestation and emergence of delusional ideas, there are several types of them:

– delusions of persecution – this is a paranoid delusion, when a person constantly has the feeling that he is being persecuted, threatened and even wants to kill,

– delirium of self-accusation – a depressive type of delirium, which is clearly manifested in a sense of guilt for an allegedly perfect act. This state of affairs can lead to suicide

– delusions of grandeur – manic delirium, which implies a clear overestimation of one’s personality. It is this condition that often lies behind the destruction of relationships in the family, at work and in society.

In science, the concept of “megalomania” is called megalomania or expansive delirium. This is a pathopsychological syndrome, which is manifested by a distorted self-perception and manifests itself through a global reassessment of one’s own personality.

There are several major factors that lead or are the source of this condition.

1. Special origin . Very often belonging to a noble family, the presence of great wealth cause growing signs of megalomania.

2. Invention or scientific activity . An outstanding scientific discovery very often leads to an increase in its significance and self-confidence. The person loses groundedness and is prone to displaying the main symptoms of megalomania.

3. Reformation . A person’s belief that he must radically change certain events makes him show his primacy and importance among others.

4. Love nonsense . This is a global idea that a famous person is in love or in love with him, and in this case the importance of his (her) person increases.

5. Messianism – a person’s belief that he is a prophet and has an important destiny before the people.

It is difficult to say that men or women are more susceptible to such a pathopsychomatic syndrome, but in any case, it is important to contact specialists at the first signs or sensations of such a manifestation.

The main symptoms of “delusions of grandeur”

The idea of one’s own greatness affects not only thinking, but also significantly changes a person’s behavior. All his words and actions are aimed at demonstrating his uniqueness. The main symptoms of “delusions of grandeur” include:

– a clear and global focus on one’s personality,

– belief in one’s own uniqueness and significance,

– identification with a famous character,

– focusing only on one’s own opinion,

– a confident and clear sense of superiority over everyone,

– absolute immunity to criticism.

Having identified the main symptoms, it becomes obvious that a person who has such manifestations is not safe not only for society, but also for himself, especially in the case of a neglected situation.

The main and global problem of “megalomania” is a state of depression, which in 41% of cases leads to suicide.

It is important to note that “megalomania” is not treatable. In the process of treatment and observation, specialists identify the focus and the cause of such a deviation and treat it as the underlying disease.

With mild forms of the disease, treatment occurs on an outpatient basis, with more complex forms, it is already stationary.

Often, children who study flawlessly at school, win prizes at olympiads, and win medals at competitions, are subject to the “excellent student syndrome”, which is a direct or indirect payment for success. In psychology, this syndrome borders on perfectionism, but has its own special features that betray its presence. Therefore, it is quite possible to diagnose yourself by choosing the treatment on an individual basis.

Key Features of the Excellence Syndrome

Having understood the terminology, it will not be difficult for any person to understand whether he is prone to the syndrome of an excellent student. Such a phenomenon as a set of psychological characteristics of a person, due to the presence of which he shows a desire to achieve the best result, is called the syndrome of an excellent student. At the same time, for a person, the priority is to achieve success and encouragement, and not the process and benefit.

The syndrome can affect both children and adults. In childhood, the deviation occurs unconsciously, while in the older group of people there is the possibility of awareness of what is happening. Symptoms often include symptoms such as:

• variability of self-esteem, strongly dependent on outsiders’ opinions;

• comparing your results with the successes of others;

• the presence of a constant fear of making a mistake, and therefore the refusal to implement something new;

• a constant desire to please the desires of other people;

• emergence of envy at the best result of contenders.

Also, the tendency to develop depression after making a mistake is a clear indication of the development of the syndrome. At the same time, fear of making mistakes, fear of the opinions of others and fear of criticism are considered key aspects of the disorder. Along the way, people with an excellent student syndrome live with other people’s values, ideals, sometimes without realizing it themselves.

Typical mistakes indicating the onset of the syndrome

Often, the syndrome of an excellent student in children and adolescents develops as a result of pressure from adults and their use of phrases that can send a child on the path of an excellent student. The dialogue will certainly include the following questions:

• “How was your day?” instead of “How are you?”;

• “Did the others make it?”

Also, the person himself can contribute to the formation of the disorder through incorrect thinking. Then such phrases as “I’m afraid to forget to say something during the speech” or “I’m worried that I won’t be able to do something according to the planned scenario” will be clearly traced.

If it is not possible to immediately track the origin of the problem, then it is advisable to resort to checking yourself by passing tests, questionnaires devoted to a comprehensive assessment of personality traits:

• on the Dembo – Rubinshtein self-assessment scale;

• according to the standardized multifactorial method of studying the personality of L.N. Sobchik ;

• armed with a multidimensional Hewitt -Flett perfectionism scale .

In the event that a problem or disturbing symptoms are detected, it is better to immediately take effective measures to prevent the situation from aggravating.

Ways to get rid of the excellent student syndrome

Although susceptibility to this personality disorder is a common problem, it is possible to get rid of it on your own with a certain amount of effort.

1. Awareness of the problem (accepting the fact that the presence of a syndrome is a vulnerability in a person’s characteristics is the first step towards getting rid of the problem).

2. A closer look around (trying to understand your own environment, which forms the wrong views, allows you to eliminate from the circle of friends, acquaintances who are toxic people who encourage the appearance of the syndrome).

3. Give yourself permission to play pranks (due to the fact that the problem comes from childhood, it is important for a person of any age to allow himself to be imperfect, and give himself the freedom to play pranks from the heart).

4. Eliminate the habit of comparing yourself with other people (you should switch the focus from the result to the process, prioritizing your own needs, not looking back at the achievements of others).

5. Passing a special online program (Psychic Self-Regulation will help you quickly improve your own state of mind, a program that, after completing it in 6 weeks, will be able to forget about the presence of the excellent student syndrome in your life).

6. Familiarization with narrowly focused books (deep immersion in the topic can be achieved by reading the works of Ruby Wax “Being yourself”, Erich Fromm “Man for himself”).

In order to prevent the development of the syndrome from childhood, it is important for parents to praise their own child, paying attention to the ability to do something on their own, and not to receive high marks for the actions done. The manifestation of love, benevolence will become good companions on the way to the formation of a healthy personality of a growing child.