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  1. Mental disorders in traumatic brain injury
  2. Mental disorders in the long term and treatment after traumatic brain injury

Traumatic lesions of the skull play a significant role in the origin of the various types of psychopathology, including psychosis and different structures. In our country, traumatic brain injury (TBI) are diagnosed each year in four individuals in the population by 1000 (l. b. Likhterman et al, 1993). In the United States from its effects each year 2 million people suffer. Among the victims in connection with a traumatic brain injury is dominated by men. Particularly prevalent disorders due to traumatic brain injury observed during the wars. N. and. pies characterized as traumatic war epidemic. Currently in Russia in the structure of this pathology is dominated by domestic nature TBI recently been an increase in road accidents.

Brain damage caused by head injury, divided by the concussion (concussion), bruises (contusions), compression (compression). Such a division is to some extent arbitrary, in many cases diagnosed concomitant injury. With typical manifestations of TBI (T90), arising in its result, mental disorders can be divided in accordance with the stages of traumatic injuries. Mental pathology is characterized by an initial period of shutdown states of consciousness (coma, stupor, stunning - see Chap. 13 "pathology of consciousness"). In the acute phase mainly developed acute psychosis with states stupefaction: delirious, epileptiform, twilight. In the period of convalescence or late period dominated by subacute and prolonged traumatic psychosis, which can be repeated periodically to take over. Mental disorders remote period TBI appear as options in the structure of psycho-organic syndrome traumatic encephalopathy.

In the acute phase (Immediately after the injury) Causes loss of consciousness, with stunning, stupor or coma. Further course and prognosis in such cases determined by the duration of unconsciousness and degree of severity. Currently, high-quality emergency care allows you to make a favorable prognosis with a significant improvement in mental status, even after long-term (several weeks) lack of consciousness. It is believed that if the duration of coma for over a month qualitative recovery of mental functions is problematic, but the experience of the Great Patriotic War showed that in some cases regredientnost flow such that recovers an acceptable level of adaptation. Exit from prolonged coma is usually gradual, with the restoration of eye movements, emotional reactions to treatment staff, relatives, with the advent of more and restoration of his own speech. Chronically displays sharp exhaustion (asthenic syndrome) with severe autonomic disturbances. Marked irritability, affect lability, one of the obligate signs of this condition is hypersensitivity, increased sensitivity to all external stimuli. In the acute stage of the disease with traumatic head injury may cause various psychotic states as exogenous forms of reaction, by building Bogefferu (1912). They are an intermediate stage between unconsciousness and full recovery of consciousness.

Delirium develops mainly in people who abuse alcohol. Often recorded a typical pattern with a predominance of illusory hallucinatory manifestations affect anxiety, fear, behavior is caused by abnormal experiences (see "alcoholic psychosis").

Clouded state often occurs after an additional harmful effects develops rapidly, accompanied as delirium, illusory, hallucinatory disorders, but often occurs secondary delusions, expressed anger, dysphoria with destructive tendencies, can also be observed pattern of ambulatory automatism. This period completely amneziruetsya after his permission.

Oneyroid - A relatively rare manifestation of psychoses in TBI - develops in the early days of the acute period of the disease on the background light drowsiness and adinamii. Patients experiencing a kaleidoscopic picture of successive fantastic content, with predominant complacent euphoric mood background. Fantastic plot bears the stamp psevdogallyutsinatornoy pathology. Oneyroid duration does not exceed two or three days, with the expressed asthenia.

Korsakoff's syndrome occurs most frequently immediately after the disappearance of stunning, in such cases detected phenomena fixation amnesia, confabulation, retrograde amnesia. Korsakoff's syndrome is accompanied by post-traumatic genesis disorientation in time. R. I. Golant described cases where the development of the Korsakov syndrome follows directly from traumatic delirium. Most often, this symptom is formed after prolonged loss of consciousness, especially long coma.


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