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Concept "Post Traumatic Stress Disorder"(PTSD) - a new diagnostic unit introduced in ICD-10.

Necessary condition for PTSD is considered a factor in an individual's involvement extraordinary situational events with high-powered impact on the psyche. According to some researchers (Girolamo, 1992, etc.), although post-traumatic stress disorder (PTSD), the majority of patients is associated with such traumatic events in relation to the mind, it does not mean that the same disorder can occur in some people in situations not related to the "extraordinary", but for various reasons are for their serious psychological trauma.

Before committing PTSD independent categories such violations were the closest to the clinical concept of "traumatic neurosis» (X. Oppenheim, 1888), appeared in connection with the description of the mental effects of a train crash. Later coined the term "war neurosis" (C. Barrois, 1907).

Describing a form of "mental disability acquired" for young people who did not have the experience and knowledge which time put forward in responsible positions that require complete dedication, regardless of the forces, PB Gannushkin identified three groups of symptoms. The first he attributed greater excitability and irritability, which goes beyond asthenic irritable weakness. The second group of the more common symptoms of depression, he took attacks of varying intensity and duration that related with the constitutional basis, the patient's response to this or that painful experience that took place in the past. Finally, the third group of symptoms as the most common manifestation, is a different kind of hysterical psychogenic disorder. The disease develops within two to four years and leads "to a permanent, incurable weakening of intellectual activity" (PBGannushkin, 1927). As a result, severe fatigue - physical, intellectual, moral, by PB Gannushkina - patients develop loss of small vessels of the cerebral cortex and thus functional (neurotic) disorder becomes organic.

VM Morozov, a disciple of PB Gannushkina, described progressive asthenia and progeria prisoners of German concentration camps (1958). They develop various bouts of emotional ekmnezii burly thoughts (ideoreya) and the prevalence of painful memories of the past.

As defined by ICD-X for PTSD "lag occurs and protracted response to a stressful event or situation exceptionally threatening or catastrophic nature, which in principle can cause major distress almost every person." From here are two obvious features of this pathology: the deterministic nature of psychogenic disorders, and certainly of the utmost gravity psychogenic.

Prevalence. Data on the prevalence of post-traumatic stress disorder (PTSD) in survivors of extreme situations, detect vibrations from 10% in the witnesses of the events up to 95% of heavily affected (including with physical injuries). In the domestic literature Y. Popov and VD Kind (1998) gave a prevalence of PTSD had a severe stress, equal to 50 - 85%.

CLINICAL PRESENTATION

Posttraumatic stress disorder (PTSD) develops after an acute stress reaction (F43.0), which is characterized by the appearance of fear, agitation, confusion, in some cases - stupor, reaction of anxiety, panic, narrowing of consciousness, memory disorders. Sometimes there are acute psychosis with disorientation, auditory and visual hallucinations, reflecting experienced events.

Unlike acute stress reaction post-traumatic stress disorder (PTSD) occurs not at the time of emergency events, and long-term periods.

Specific to PTSD clinics are considered recurring symptoms associated with the content of a traumatic situation. These include intrusive memories (ideoreya by VM Morozov), with constant thoughts or feelings; depressing, heavy dreams, which reflect those events, disorders of perception, sensations that correspond constantly recurring event of tragedy or disaster. May cause delusions, hallucinations psychogenic content. It can appear in prosonochnyh states. In children, such symptoms occur the same way as it happens in adults, but it appears not so differentiated dominated vague fears, nightmares.

Characteristic symptom of PTSD, which determines the specificity of the disease is considered constantly repeated figurative representation of the nature of the photographic clarity the most significant traumatic event (flashbacks). Similar phenomena may occur without any external stimulus.

Much more severe reactions occur in patients with PTSD in response to events that resemble they had endured in the past. Example is the reaction of the German prisoners of concentration camps in the form of swastikas and other forms of Nazi paraphernalia, etc. In many cases, the fore sleep disturbances, irritability, explosiveness. May develop severe depression, anxiety disorders, alcoholism. Patients look sullen, alienated, withdrawn, they become difficult to even communicate with family and friends because of irritability, aggressiveness turning into outbreaks of unwarranted anger. Usual requirements of work discipline and subordination to them becomes an almost impossible that often ends in heavy conflict, resulting in the need to leave work. Similar events may occur in the family, which leads to its disintegration.

The presence of severe psychopathic behavior in patients with marked depression, anxiety, sadness, thoughts of complete hopelessness, can sometimes occur taedium vitae.

For all patients characteristic, except recurring memories, autonomic disorders. Formed a special self-centeredness, patients believe that the world of other people, their interests crayons void. They do not seek help, believing that doctors can not provide appropriate assistance, even chat with fellow sufferers lived through together is not so much soothing as painful as again makes remember painful events.

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