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Korostiy V., Zavorotniy V., Polishuk V.
Pharmacotherapy in complex treatment and rehabilitation of PTSD.
INTERNATIONAL JOURNAL OF NEUROLOGY 6 (76) 2015. P. 59-71
This could be a place for your table.
© 2017 V.Korostiy vikorostiy@ukr.net
Volodymyr Korostiy, Kharkiv National Medical University, University Clinic,
Psyhyatry, narcology and medical psychology department
Introduction. Over 1,5 million Ukrainians were forced to leave their
home after Crimea annexation and military conflict in the East of
Ukraine. Most of them displaced to Kharkiv region and nearest
territories.
Objectives. By 2015 the University Clinic asked 156 people displaced
from areas of Lugansk and Donetsk regions. Only 65 of them had
official status of IDPs. Reasons treatment all patients were somatic
complaints. In screening using the scale hospital all patients were found
higher rates of anxiety and depression. 48% of patients abandoned
psychiatric examination, even 24% of psychological counseling.
Aims: development and improvement of methods of prophylactics,
diagnosis and treatment; improving the efficiency of diagnostics and
treatment; obtaining competitive scientific and applied results.
Screening of IDPs’ mental health who sought medical help in somatic
clinic (University clinic of Kharkiv National Medical University) and
estimation of efficiency of interdisciplinary treatment and complex
rehabilitation.
Methods: clinical and psychopathological, based on conventional
approaches to psychiatric assessment by interview and observation;
psychodiagnostical metods (HADS, HDRS, HARS, SCL-90R, methods
of studying stress overcoming behavior styles: "Ways of coping”
(Adaptation T. Hook, 2002); "Determination methods of conflict
resolution" Thomas K. adaptation NV Grishin; integrated assessment of
quality of life scale (Mezzich, Coher, Ruiperez, Liu & Yoon, 1999 in
modifications Maruta NA 2004).
Results. Screening of IDPs’ mental health who sought medical help in
somatic clinic (University clinic of Kharkiv National Medical
University) and estimation of efficiency of interdisciplinary treatment
and complex rehabilitation.
Clinical examination during the period of acute stress reactions was
observed, dominated by anxiety disorders, prolonged depressive
reaction. Anxiety disorders were found in 56.5%, prolonged depressive
reaction in 32.0%, post-traumatic stress disorder in 10.5% of patients.
Psychosomatic disorders were 80% of patients. The treatment of the
underlying disease, complex psychological and physical rehabilitation.
Psychological rehabilitation included CBT, relaxation, art therapy.
Physical rehabilitation includes kinesiotherapy and TRE. A set of
measures of physical rehabilitation for 14 days led to reduction of
anxiety to physiological levels in all mentally healthy patients, reduce
the severity of psychosomatic symptoms in the structure of the
underlying disease, increased satisfaction with the results of treatment
by 28.5%.
Interdisciplinary treatment and complex rehabilitation of
internally displaced persons in University Clinic
Analysis of mental health study of IDPs and evaluation of
comprehensive rehabilitation in the University Clinic show the need for
screening mental state when applying for medical assistance and the
desirability of psychological and physical rehabilitation of patients
during hospital stay somatic profile. The efficiency of the correction
system, prevention posttravmatic stress disorders and rehabilitation,
reduce the frequency of clinical manifestations of PTSD by 5.6%, barns
poor mental disorders 8.5%, duration of disability at 10.4%, improving
the quality of life in 12.6% .
Model of treatment and prevention of mental disorders IDPs when
applying for medical assistance on somatic diseases, to develop a
comprehensive system of rehabilitation of IDPs.
1. Psyhoeducation in IDP’s.
2. Identify persons with risk factors for PTSD: nadtyazhki, repeated
and prolonged stressful event; lack of social depreciation urgent
relocation, resettlement "third wave", the presence of family members
who remain in a combat zone is the lack of activity on the feasibility of
avoiding or countering the action of stress factor.
3. Using the screening methods detect PTSD in primary care general
practitioners and family medicine.
4. Prevention of posttraumatic stress disorder, psychopharmacological
and psychotherapeutic intervention in the "golden hour" after exposure
to stressful events.
5. Psychological correction is not adaptive coping strategies in these
categories of persons in the period of adaptation to new environmental
conditions (after resettlement, demobilization, release from captivity).
6. Rehabilitation of patients with PTSD, comprehensive, multimodal,
continuous.
Conclusions. the topicality of the research is due to the current high
prevalence of mental disorders in IDPs. Resalts improved the efficiency
of treatment and rehabilitation of comorbid psychiatric disorders in
IDPs with somatic pathology, during the treatment of patients in
somatic hospital.