Generalization of the alarming solution of drug administration. Causes, symptoms and symptoms of generalized anxiety disorder. Skargi and anamnesis
Generalization of trivial discord є psychotic discord, as it turns into a camp of triviality. This is a trivial term and is not tied to specific reasons for seeing situations or objects. Ailments come from the discomfort and morality of the citizen. Perebіg hvilepodіbniy: in the period of time it’s trivial to accommodate, and in the past, it becomes a backdrop to the background.
Generalization of the tricky discord - the children of the psyche, tied with the tricky
By itself, it will become more often to look at you as something that is not a serious contamination. It is often the case that those who are tied to the beaten ailments are often tied to them, but they have some physical problems and try to know in themselves ailments of the heart-vascular system, the intestinal tract, and others. In the first place, it manifests itself in physical visions, such as superficial symptoms of anxiety. In some cases, there are some problems with drugs, old patients in the fact that there are no serious problems with them. Tіlki buvaє also do not expect.
At the practice of generalization, a tricky distribution is a plant that is most often combined with one another. In the emotional spheres - chronic disordered mood, depressed or cyclothymic. So the most possible manifestation of phobic discord or obsessive-compulsive. It is not a matter of thought to him, but a small dibnychka, like a vine from a hvilyuvannya.
Seemingly, generalized discord often occurs among women, and children are in chronic environmental stress. All in all, it’s possible, but because it’s easy to finish, it’s easy to surrender to the fact that the tachycardia is tied to the camp of the psyche. Only it is unlikely that this year, there have been many more problems.
Generalization of anxiety disorders: symptoms
Signs of a trivial guilt are spoken by the most recent term, most often - a few months. When a lot of patients are more than a part of the hour, I see a trifle, but I do not see it.
- Poboyuvannya, ochіkuvannya bidi... Vono may be tied to the concrete, and may be immaterial. It’s hard to see a hvilyuvannya with a concentration of respect.
- motorne napruga... Rozslabyitsya not to go, m'yazi to make. Tremor and headache may be spontaneous.
- Signs of autonomic dysfunction... Eagerness, often turn around in cold sweat. Tachycardia, teasing of the slunk or rectum, signs of hyperventilation, zamorochennya.
Lyudin, who is overwhelmed by a generalized disagreement, gradually ochіku bidi
Before setting the diagnosis, it is necessary to diagnose neurasthenia. Bagato razladi generalization anxiety not skasovyat, zokrema - depression. Uvaga, it is necessary to come and self-sufficient self-illnesses.
For example, thyrotoxicosis, for example, with ischemic ailment of the heart, which sometimes suffers from similar symptoms. I didn’t know about those who didn’t think that they’d gotten lucky and didn’t have any big ideas about it.
Generalization three-way breakdown: likuvannya
For the methods themselves, one can go for out-of-the-box psychotherapy and medication therapy, and for straightening out on usunennya one feels the most troublesome and superficial and somatic signs. Potentially with medicines. In presenters and thematic articles, you can add a magnificent list of different types and types. Pererakhumo mainly from the tsієї of writing and, as it were, which we should not be like.
- tranquilizer... It is widely recognized in our hour that the reason for 90% is in the inertia of the misdirection of the drugs, as the price. Do not give any therapeutic effect. It is a great idea to reduce the health of the concentration of respect, which is a great risk of unhappy vipadkiv in outpatient treatment. The body is called up to the fact that the symptoms of anxiety are consumed only before they are injected, that dose needs to be consumed. The conversation of tranquilizers is tied to the great rizik. The sound of the stench wicks. Lіkuvannya be-like razladіv, tied with a tricky leg, - a whole lot of wanderings.
- types of antipsychotics... You can tell all those same things about tranquilizers. They were not called “great” tranquilizers, but benzodiazepines “malimi”. Yakis extrapiracy and neuroendocrine side effects inevitably at the lowest doses. It is even more serious for those who have all the symptoms of antipsychotics associated with situations, if for generalized anxiety to look at the signs of something else, and we call you to look for unkindness.
- Β-blocker drugs... In the meantime, there is a tremor and an accelerated heart rate, as you do not pass through the intake of other drugs.
- Atarax (hydroxyzine)... Efficiency has been brought, but at the same time it is a short-line design. Nothing in general does not change, only for the last few years.
- Afobazol (Afobazole)... It's a bit of a question to say that aleeffectiveness is not communicated to any of the vip tests.
The whole list can be expanded, but not in that special sense. From our point of view, lіkuvannya guilty based on antidepressant and complex psychotherapy. At the same time, do not be astonished at all types of drugs, antidepressants and antidepressants will become robust with paroxetine, we see the trademarks “Paxil”, “Paroxin”, and sertralin.
When you go to the therapy, then the food is simple and foldable at once. It is possible with the absolute splendor of the tale, that all the signs of the disposition can be easily known by simple rights for relaxation and dizzying gymnastics. However, our civilization gave birth to a divine type of people. The proponent psychotherapist is simple right. It is necessary to go to the pidlog, and after the release of the box. Kind, okay, well, call me forever from every point to the eye. True, he got lost in the word “Shavasana”. This is how the pose for relaxation is called lying on the back. Immediately bump the axis of the eyes and the chuє of drilling "Who do you think you will be here?"
The reaction is typical. People on the go can come up with some ways to prevent them from ruining those, just once they could help. Call the customer the check that the psychotherapist will hear from you. The verbal twist of the trivial distribution of the generalized is rich in what to lie in as a type of specialty. There is a dramatic discussion about one's own ailments, there is more to talk about depression, not about the experience of troubles itself. Admittedly, the therapist has a dozen of priyomas in his arsenal, as hundreds of times have brought their effectiveness.
Approximately one in 20 children with hearing and starting practice. Navit then come, just clarify - why is it right to rob everything. Well, great, what are you talking about? Tilki scho depression and triviality, and here we also practice pranayama, yoga practice, meditation. Chi dopomagaє? The same hostility, which is a good deal for that and іsnuyut, how to nagadat people, but it’s not a shmatok of live meat, ale a ludin, but it’s not just a psyche, but a soul.
For the treatment of anxiety discharges, there can be used tranquilizers.
Інші 19 marvel at yakimos skepticism. First of all, it stinks, so all of them will be viciously rinkovy. See yourself as buyers, or as customers like in Perucarni. In a different way, vvazhayut vlasnі dії unacceptable. It is not necessary to think about how to be beaten by the same general terms, or the word "meditation". Unacceptable looking at the movies. It’s not like being beaten before self-defeats. And people can easily know advertisements for a drug and "prescribe" for themselves.
Trippy breakdown and panic attacks
Generalization of the three-way distribution in the ICD-10 is represented by a single one with the code F41.1. The food is known to be epizodic and paroxysmal anxiety, as in some cases it is called an anxiety panic disorder. However, it’s not worth talking about those, which are not very complex options, if people see little trifle not permanently, but only occasionally attacked by panic attacks. All the tsya "beauty" is easy to pass into agoraphobia with panic distribution. A gift from a human being with a foil cap on the head is not entirely safe. With the hats, all the three folds and grows in the edge.
And the axis of agoraphobia of this type is more frequent. Who will you see? Ailments of the most open space should not be afraid. Along with them on the street, or in the huge transport, they trawl to attack panic attacks. All the same, there are a lot of depression or anxiety. As a result, the situation is even unacceptable. From the family and the close ones, friends smell the stench that they have let themselves go. Smell and do not get confused, let’s let them in, let’s go yak?
First for everything - do not go out of your way from those close to you, because all one does not sound. It is necessary to ask loved ones for help in order to reach a psychotherapist. Especially the author of the tsikh ryadkіv thought Paxil... Vines can become a loss of the individual intolerance.
Paxil will paint the psyche with anxiety
Tricky generalized discord: lіkuvannya mantras
It is then necessary to know the techniques of robots with confidence and wit in one hour. Skilki we have everything written and said about those who are pratsyuvati and scho robiti. A lot of techniques can be found in the articles on the site. However, the author of the tsієї of nothing short, I don’t know the mantra "So-Ham". Simple, miraculous and neurologically effective. Pratsyuvati with a mantra you can wish 24 years for additional and 7 days for a day. Dopomagaє in navazhchih vipadki. The essence of the practice can be explained as follows.
It is necessary to associate it with the sound of "Z", and when you see it with the sound of "Ham", try to feel the sounds in the vibrations of the powerful ecstasy. No more robustness is needed. Yak taka, in the context of yogic practice, the mantra becomes a way to "anger" inhale and see in one process. Details can be found on the top yoga and meditation sites. For us, about the panic attacks, we are talking about the panic attacks, to finish the extraordinary, cob ravine of practice.
To see the results. The evidence is seen as somatic signs, and we will learn about them in time. All the trouble and you will change in the fact that generalization is not so scary with panic attacks, as you can only think about it.
The change lies in the fact that pratsyuvati is possible at any moment. For example, 20 chilins are static, sitting on a stile with a straight back. At the same time, you can try to grow so that you can wrap up the vidih and vidikha by tying it with the Perednesredinny channel. You want to know the details of yourself, and we can describe them in the fabulous rice. Find out that from the region of the larynx to the region of the navel to pass the gap of the tube. When you inhale, it goes down, and when you see it, it goes down like a substance. Tse well supervodzhutsya vidchuttyam sound "Z" in vidihu, and the sound "Ham" in vidihu. Dikhannya is spokiyne, naturally, piece-wise, it is not necessary.
Regular practice can help you not only to get overwhelmed in the face of trivialities, but to go through the "crush" panic attack.
As a matter of fact, there are more methods to use it. vidminny effect bring the practice of qigong, busy with meditation and yoga. All the same is described in the medical literature. And if it is described, then in which it is called is also an adapted version. The reason is that the materialistic foundations of science do not allow to see the power of bioenergy and reach a great number of speeches, which are related to the phenomenological reality. Here we have є one perevaga. We can not check for a day. Yakbi psychology checked knowledge, then I won’t have the opportunity to engage in psychoanalysis.
Chitannya mantras of additional help
Tsey that kind of problems, if a skin psychotherapist can be for himself. As the spoken vishche, a larger part of it doesn’t want to, and vvazhaє for more beautifully promoted to pushers anyway. It’s not filthy, it’s only not necessary for grasshoppers. Once again, it’s nagadamo that natural - zovsim does not mean safety. Mukhomori and black toadstools, bleakness - everything can be natural, only those who are not old are not safe.
The breadth of the generalized tripode distribution (GTR) is 6%. Median ear for ear is 31 rubles, average for ear is 32.7 rubles. The breadth in children is 3%, in children - 10.8%. As soon as children get sick and for children - between 10 and 14. On the day, you should consider those who have GTR women develop 2-3 times more often in terms of people, as well as for those who are very often. The process of disagreement is often overlooked, and less than a third of the patients will accept it adequately. It’s becoming easier to grow faster, so it’s possible, you need to distribute GAD in children and GAD in older adults.
GTR is tied with functional destructions and destructions of life. In case of primary malignancy to a doctor, 60-94% of patients with GAD skary on ailing physical symptoms, and in 72% of patients there is a reason for the joke of medical help.
I represent your opinion about the transfer of key recommendations from the generalized troublesome distribution, folded by the experts of the Canadian Association of the troublesome distributions. Transfer of food preparations by the spilny zusillas to the scientific Internet portal "Psychiatry & Neurosciences" and Clinics of Psychiatry "Doctor SAN" (St. Petersburg).
comorbid
The GTR is associated with a high level of comorbid mental disorders, including some troublesome problems and a great depressive disorder. Rizik somatic ailments have also been increased, including pain syndromes, hypertension, problems with the heart-vascular system and slag. Evidence of comorbid depression advancing the severity of ailments.
diagnosis
The GTR is characterized by a sliding triplet and hvilyuvannya (more than a part of the days stretching the remaining six months) from the drive of agile motions and types of performance, for example, the task of robots. In addition, the GTR associates with restlessness, myazovuyu vprugoy, at the same time, problems with concentration, drastic and disturbed sleep.
DSM-5 Criteria for GAD Diagnosis
- Nadlichkova triviality and hygiene (trivial clearing) for the drive of smart podiatry and types of performance, for example, newbies or robots.
- Lyudina sees difficulties in establishing control over hvilyuvannya
- Overwhelming anxiety and lack of knitting for a minimum of three from the onset of symptoms, so that a person will be worried for more than a part of the day for a minimum of six months:
- Fatigue, for seeing oneself “on the platoon”, “on the edge”, swelling of stamina, folding with concentration, dreadfulness, myazov's spill, or disturbed sleep
- Rozlad viklikak clinically significant distress or functional destruction
Psychological help
Meta-analyzes clearly show that CBT will significantly reduce the symptoms of GAD. In a small number of cases, the development of CBT and pharmacotherapy, which showed approximately the same strength of the effect, has been adjusted. Individual and group psychotherapy, however, is equally effective at relieving anxiety, but individual psychotherapy can be more effective in reducing depression and relieving depressive symptoms.
The intensity of psychotherapy was estimated in the meta-analysis of 25 days. For weakening anxiety, the course of psychotherapy is trivial for less than eight sessions, so the most effective course is trivial for more than eight sessions. For a weakening of hviliuvannya and depression, a greater intensive course is more effective, less a course with a small number of sessions. Kilka doslidzhen showed the IKPT cinnamon.
Meta-analysis does not know significant progress in CBT and relaxation therapy. However, it is more recent to talk about the interchange of the effectiveness of relaxation therapy. The scale of PCI showed that balneotherapy, relaxation therapy with spa procedures, better than SSRIs, reduce anxiety; however, it is clear that the information has been carried out correctly.
The effectiveness of behavioral psychotherapy, based on acceptance, metacognitive psychotherapy, CBT, aimed at correcting the loss of unimportance, based on the assimilation of cognitive therapy has been brought.
Psychodynamic psychotherapy can give a result, but at least a moment of clear proof of the effectiveness of the disease is not possible.
Addition of interpersonal and emotional-process therapy to CBT does not give a lot of gains in terms of CBT without supplementation. From the front to the ear to the ear, the CBT course additionally helps to change the opir of therapy, polish compliance - this strategy is especially important in important issues.
Combination of psychotherapy and pharmacological treatment
There are three tributes about victorious combination of psychotherapy and pharmacological treatment. The meta-analysis has shown that the combination of pharmacological treatment with CBT is less effective than one CBT, as well as the results and results immediately after the course of treatment, but not through a series of months. Available data for a few days, such as a combination of diazepam or buspirone plus CBT with one CBT. There is not a large number of dosages, since pharmacotherapy with pharmacotherapy, before they have been given psychotherapy, give superb results.
At the moment, there is no dressing for combining CBT with pharmacotherapy. Ale, as well as in vipad with other anxiety discharges, if the patient is not more beautiful than writing CBT, it is recommended to take a pharmacotherapy. Let’s choose the rank, if it doesn’t become more beautiful as a pharmacotherapy, then it is possible to check it as a CBT. Meta-analysis and RSI talk about preserving the results of psychotherapy for 1-3 periods of time.
pharmacological treatment
With the treatment of GAD, the efficacy of SSRIs, CIOZSiN, TCA, benzodiazepin, pregabaline, and quetiapine XR was improved.
Persha line
Antidepressants (SSRIs і СІОЗСіН): PCI to improve the effectiveness of escitalopram, sertraline and paroxetine, as well as duloxetine and venlafaxine XR. The effectiveness of SSRIs and СІОЗСіН is the same. Є Dani, etsitalopram is less effective, lower venlafaxine XR or quetiapin XR.
Іnshі antidepressants:Є prove that agomelatine is so effective in itself, like escitalopram.
pregabalin: The efficiency of pregabaline is the same as that of benzodiazepines (proof 1).
friend line
benzodiazepini: The effectiveness of alprazolam, bromazepam, diazepam and lorazepam has been reported (proof of evidence 1). If you want to prove a high one, the preparation is recommended as a result of another line and for short-line stasis through side effects, which leads to the syndrome of vision.
TCA and іnshі antidepressants: Imipramine in the treatment of GAD is so effective as benzodiazepini (proof 1). Ale through side effects and potentially toxic overdose, imipramin is recommended as a different line. Danikh about bupropion XL trocha, ale afterwards, in which case he showed the same efficiency as estsitalopram (because of the first line), that is why it is possible to choose from another line.
Vortioxetin, so called serotonin modulator, is injected into the serotonin receptor. The results of the improvement of the effectiveness of vortioxetin are super-verbose, ale є dans of those who are victorious in case of GAD.
Quetiapin XR: The efficacy of quetiapine XR has been brought to the same level as the efficacy of antidepressants. Alley with the dressing for the queue with a set of vagi, sedation and food on an occasional basis with antidepressants as soon as possible and from the treatment through side-by-side... Through the problems associated with postponed and safe atypical antipsychotics, the drug is recommended as a different line for patients who cannot take antidepressants or benzodiazepines.
Іnshі preparations: Buspirone in decilcoch PCI showed the same efficiency as benzodiazepini. There is not enough money for the treatment of buspiron with antidepressants. Due to the lack of efficiency in clinical practice, buspirone has been reduced to preparations in another line.
Hydroxyzine has shown an efficacy close to that of benzodiazepines and buspirone, an alternative to the usual concomitant use of the drug in GAD is deficient.
third line
Prior to the preparation of the third line of treatment, the drugs with poorly long-lasting efficiency, side effects, are rarely stagnant in the quality of the primary treatment of GAD.
additional preparations
The strategy of administering additional drugs to patients was given to patients, who did not give an adequate response to the diagnosis of SIZZS, and could be stuck in the case of resistant GAD.
Additional preparations of other lines: Pregabalin to the complement to the main drug has shown efficacy in patients with treatment, but they did not give evidence for anterior treatment (level of evidence 2).
Additional preparations of the third line: The meta-analysis did not show a fullness in the presence of atypical antipsychotics as supplementary drugs, but instead showed an increase in the frequency and shaving of the drug. Superb results show the continued effectiveness of risperidone and quetiapine in supplemental preparations.
Due to the poorly improved efficiency, risk of a set of vagi and metabolic side effects, atypical antipsychotics, it is necessary to provide for resistant patients with GAD, with the blame of Quetiapine XR, to reduce the amount of drugs to the main drug.
a drug |
rіven reporting |
SSRI | |
escitalopram | 1 |
paroxetine | 1 |
sertraline | 1 |
fluoxetine | 3 |
citalopram | 3 |
СІОЗСіН | |
duloxetine | 1 |
venlafaxine | 1 |
TCA | |
imipramine | 1 |
іnshі antidepressants | |
agomelatine | 1 |
Vortioxetin | 1 (supervised data) |
bupropion | 2 |
trazadone | 2 |
mirtazapin | 3 |
benzodiazepini | |
Alprazolam | 1 |
bromazepam | 1 |
diazepam | 1 |
lorazepam | 1 |
anticonvulsant | |
pregabalin | 1 |
Divalproeks | 2 |
tiagabin | 1 (negative result) |
Pregabalin yak dodatkovy drug | 2 |
іnshі drugs | |
buspiron | 1 |
hydroxyzine | 1 |
Pexacerfont | 2 (negative result) |
propranolol | 2 (negative result) |
memantine | 4 (negative result) |
Pindolol yak dodatkovy drug | 2 (negative result) |
atypical antipsychotics | |
quetiapin | 1 |
Quetiapin yak is a supplemental preparation | 1 (supervised data) |
Risperidone yak dodatkovy drug | 1 (supervised data) |
Olanzapin yak dodatkovy drug | 2 |
Aripiprazole yak dodatkovy drug | 3 |
Ziprasidon yak monotherapy abo in combination | 2 (negative result) |
First line: Agomelatine, duloxetine, escitalopram, paroxetine, pregabalin, sertraline, venlafaxine Another line: Alprazolam *, bromazepam *, bupropion, buspirone, diazepam, hydroxyzine, imipramin, lorazepam *, quetiapin *, vortioxetin Third line: Citalopram, divalproex, fluoxetine, mirtazapin, trazodone Dodatkov_ preparations (another line): pregabalin Additional preparations (third line): Aripiprazole, olanzapin, quetiapin, risperidone * Cich preparations have their own mechanisms of action, efficiency and safety profile. In a number of drugs of other lines in a large number of vipadkiv more vikoristovuvati benzodiazepini, as well as a rizik malignant; Bupropion XL is more colorful at times. Quetiapin XR is a good vibe, if you talk about efficiency, if you look at metabolic problems associated with atypical antipsychotics, it is more useful for patients who do not need antidepressants for benzodiazepines. |
Adaptable pharmacological therapy
A meta-analysis showed that a trivial use of SSRIs (6-12 months) was effective for a relapse (estimated chance of relapse = 0.20).
Relapse of 6-18 months of taking duloxetine, escitalopram, paroxetine and venlaaxin XR was reported in 10-20% of cases, in some cases from 40-56% in the control group. Continued use of pregabaline and quetiapine XR also causes a relapse in 6-12 months.
Dovgostrokov PCI showed that Escitalopram, Paroxetine and Venlafaxine XR could help to obtain a positive result after six months.
Biological and alternative types of treatment
In general, it is possible to see it well enough for children who are not old enough.
Biological therapy: Only a small amount of evidence has shown that RTMS is effective in monotherapy and in addition to SSRIs (evidence 3).
Alternative therapy: Trojandova olea (level of evidence 1) and extract of galphimium Glauk (level of evidence 2) showed the effectiveness of lorazepam. Cochrane meta-analysis to talk about two preliminaries, how to show that paciflora is so effective as benzodiazepin (proof 2) and one thing that didn’t happen to valerian. It is a pity that the herbal preparations are badly standardized and grow very often in the part of the active speech, so it is not possible to recommend it.
The PCI of the effectiveness of the security forces is right, for the aerobic ones are right, since the addition to the main treatment showed a significant weakening of symptoms (level of evidence 2). An insight into the experience of the effectiveness of acupuncture, showing that everything before it speaks about the manifestation of the positive effect, albeit through the methodological peculiarities of the experience, the effectiveness of this type of abuse cannot be taken into account. Є Doslіdzhennya, how to talk about those who, in the presence of GAD, can be corny meditation and yoga (proof 3).
Catad_tema Psychic problems - statistics
Generalization troublesome breakdown among grown-ups. Clinical recommendations.
Generalization of anxiety disorders among grown-ups
ICD 10: F41.1
Rik hardened (glance frequency): 2016 (pereview of skin 3 rocky)
ID: KR457
Professional associations:
- Russian suspension of psychiatrists
hardened
Approved by the Russian Association _____
uzgodzheni
Science Council of the Ministry of Health Protect health Russian Federation __ __________201_ p
free-floating trivial
diffuse trivia
tricky stays
differential diagnostics of generalized troublesome breakdown
diagnostic algorithm
neurotic problems
principle of lіkuvannya generalized tricky breakdown
therapy algorithm
lіkuvannya tricky poorushny
psychopharmacotherapy
psychotherapy neurotic disorders.
The list is fast
AT - arterial vise
ALT - alanine aminotransferase
AST aspartate aminotransferase
ГТР - generalizovaniy trivozhny rozlad
ITT -integration test of anxiety
ICD - international classification of ailments
MRI - magnetic resonance imaging
MRI - magnetic resonance imaging
РСІ - randomized clients
SSRIs - Selective Ingibitories of Vital Entrainment of Serotonin
СІОЗСН - Selective Ingibitories of Vital Entrainment of Serotonin and Norepinephrine
T3 - triiodothyronin
T4 - thyroxine
TSH - thyroid stimulating hormone
TCDG - transcranial dopplerography
USK - a method for the value of the sub''active control of the specificity
BAI (The Beck Anxiety Inventory) - Beck's anxiety scale
COPE (Coping) - a technique to fit behavior
DSM - diagnostic and statistic manual of mental disorders
HARS (The Hamilton Anxiety Rating Scale) - Hamilton anxiety scale
IIP (Inventory of Interpersonal Problems)
ISTA (ch Struktur Test nach G. Ammon) - Method "I-structural test" G. Ammon, І. Burbil
LSI (Life style index) - methodology "Life style index"
MDMQ (Melbourne decision making questionnaire)
MMPI (Minnesota Multihasic Personality Inventory)
MPS (Multidimensional perfectionism scale)
SCL-90-R ((Symptom Check List-90 Revised) - Indicator of the turn of psychopathological symptoms
ShARS (Sheehan Anxiety Scale) - Sheehan Anxiety Scale
STAI (State-Trait Anxiety Inventory) - Spilberger's trivial scale
** VED - the drug is included in the list "Life Needed and lіkuvalny drugs»
# - in the instructions on zasosuvannya it is not specified dana zahovannya abo disagreement
terms and values
triviality- Negatively barbed emoticon, which turns around in the perception of unimportance, ochіkuvannya negative podіy, difficult to determine transmission. Considering the reasons for fear, the cause of the anxiety, you will not be able to grasp it, you know the fate of the people in the potential shkidlivny behavior, or spontaneously they do it according to the reason for the successful outcome of the future.
psychopharmacotherapy- tse zasosuvannya psychotropic lykarsky zasobiv in lіkuvannі psychіchnyh rozladіv.
psychotherapy- the whole system of lіkuvalnogo infusion on the psyche of the people, and through the psyche and for her help to the whole body of people.
1. Short information
1.1 Business value
Generalization three-way breakdown(ГТР) - widened і style of a trivial and sprung, not enclosed or wicked, or even with some special comforting furnishings ("obviously floating trivia"). Anxiety is characterized by chronic or recurrent interruption and may lead to severe maladjustment and increased suicide.
1.2 Ethiology and pathogenesis
Among the factors in the risik appear GAD, you see:
The special features are the stream of behavior in an unknown situation, the affectivity is negative and the safety is increased, the uniqueness of the young real person is obvious, the factors associated with the GTR are considered.
Social officials - I want the middle of the patients with the GTR to often learn to become involved in the type of hyperprotection and psycho-traumatic infusion into the child's life, this year there is no specific psychosocial factor, which is a kind of malfunction.
Genetic and physiological officials - the role of genetic factors for GAD is close to 30%, the genetic factors cause negative affectivity and infuse into the manifestation of the most affective disorders, especially depressive. Vvazhaєtsya, that the genetic risk of fucking women is two times more, not for cholovikiv.
ГТР will be overwhelmed with naymensh vivchenim from all troublesome changes through the temple of comorbidity with the same moods. In this hour, we have given information about the role in the pathogenesis of GAD of the supramundane activity of the noradrenergic system, the low intensity of benzodiazepine receptors. It is also possible to evolve the problem of the immune system due to the deterioration of the fact that there is a persistently troublesome rumination that can be caused by the development of cytokines and the appearance of "smoldering ignition reactions" in the organism.
Sered psihologіchnih teorіy GAD odnієyu of naybіlsh popular Je metakognіtіvnogo teorіya zgіdno of yakoyu in patsієntіv of GAD in metakognіtіvnogo funktsіonuvannі, pov'yazanomu of lucid i otsіnkoyu Vlasna kognіtivnih protsesіv perevazhaє uyavlennya about protective i kontrolyuє realnіst funktsіyah nadlishkovogo zanepokoєnnya i katastrofіchnih stsenarіy. The fact of the fact that a large number of negative scenarios, linked to the future, are not implemented in this view of the function of positive perception and subtlety of an unsettled metacognitive model.
Psychodynamic pіdhіd vkazuє to those scho dosvіd rozluki Zi znachuschim іnshim, SSMSC uosoblyuyut Bezpeka i vіdsutnіst stabіlnoї abo perevazhannya trivozhnoї modelі prihilnostі in Rann ditinstvі only be sold to defіtsitu in strukturі osobistostі scho viznachaє perevazhannya vіlno plavayuchoyu, nefabulіruemoy trivogi over situativnoї problems in diferentsіatsії psihіchnih i of somatic findings and regulation of affective stress, which opens a pre-disposition for the management of GAD.
1.3 Epidemiology
The widening of the GAD by stretching life varies from 0.1 to 8.5%, and in the middle it becomes close to 5% in the middle of the mature population. In the middle of the other three-way breakdowns, it becomes one hundred percent - from 12 to 25%.
1.4 Code for ICD-10
F41.1 - Generalization of three-way breakdown
1.5 Classification
Classification of GTR:
Chronic generalized disorder
Recurrent generalized disorder
1.6 Klinichna picture
Generalized trivia:
Triva not less than 6 months;
Zakhoplyu developmental aspects of the life of the patient, furnishings and visions;
It is straightened very well on the maybutnі podії;
Do not succumb to control, її it is unwise to strangle the Zusilli will with any rational overconditions;
Not based on the current life situation of the patient;
It is not easy to supervise over feelings of guilt.
The clinical picture is presented by three characteristic groups of symptoms of GAD:
- Silence and fight, as the children are important to control and how much they are more, less to be cared for. The chain is still generalized and does not focus on specific problems, such as the possibility of a panic attack (like with a panic breakdown), settling in a twisted camp (like with social phobia) or we’ll get in trouble (with obsessive-compulsive).
The other mental symptoms of GAD are gratitude, foul concentration, respect and sensitivity to noise.
- Motor spasms, which can rotate in the muscular muscles, tremors, lack of weakness, headache (develop bilateral and often in the frontal and pylitic areas), minor muscular pains, stiff muscles of the shoulders, especially the spines, ...
- vegetative hyperactivity nervous system You may experience discomforts, tachycardia, dryness in your mouth, discomfort in the epigastric period, immorality, and other symptoms of vegetative anxiety.
Table 1.
Show character with GAD
psychopathological manifest |
the first thing is a triviality, how to appear at the viglyad: seemingly damaged, unstable or uncomfortable Seemingly, things are unreal (derealization), or, well, I saw more or less "for a reason, I am not here" fear of losing control, God or future death fear of dying Show your strength on small surprises or on a rework Difficulty getting the job done post-gratitude |
Vegetative symptoms: shlunkovo-gut dichny heart-shaped urogenital nervous system |
dryness in the mouth, difficulty with kovtanny, discomfort in the epigastria, overwhelming gas, gurgling in the stomach, nudity feeling of tightness, more and more discomfort in the breasts, difficulty in inhalation (to counteract the accelerated appearance of asthma), feeling of air and signs of hyperventilation discomfort in the area of heart, heart, heartbeat, heartbeat pulsation hastened sechovipuskannya, zniknennya erektsii, diminished libido, menstrual disorders, Timchasova amenorrhea feeling abducted, seeing uncleanness, stopping and paresthesia, drinking, tremor or tremor, flushing and chills, like seeing or seeing |
ruined sleep |
Difficulty with clogging due to late feeling uneasy when awakened. parting or superficial sleep sleep with unacceptable dreams. sleep with greedy dreams, unconscious awakening awakening in trinity the daylight seems to be due to a bug |
Factors that indicate a more friendly prognosis: a small ear of roasting; insignificant turn of social maladjustment; gender - women are older before remission.
Factors that indicate an unpleasant prognosis: abominations in mutual relations with cholovik or relatives; the manifestation of comorbid mental disorders; gender - mensch mens school before remission
Comorbid GTRs with the lowest psychic distributions:
Comorbid є a characteristic sign of GTR. 90% of all patients are diagnosed with the first diagnosis of “generalization of anxiety disorders” by extending their life to a small and insane mental disorder.
Most often there is comorbidity with the onset of mental breakdowns:
endogenous depression, recurrent depression disorder;
bipolar affective disorder;
dysthymia;
alcoholic staleness;
simple phobias;
social phobia;
obsessive-compulsive disorder;
narcotic deposition;
psychopathologically nondifferentiation syndrome of chronic vtomy;
asthenic damage.
Conjugation with somatic pathology.
Є The temporality of the somatic sickness among the patients with anxiety discharges:
allergic illnesses;
metabolic pathology;
back pain.
heart-damned sickness;
shlunkovo-intestinal disease;
respirator rozladi;
2. Diagnostics
2.1 Skargi and anamnesis
The main skargi: postyina, "free-floating" triviality, somatovegetative porosity.
2.2 Physical conditions
2.3 Laboratory diagnostics
It is recommended to carry out an analysis of blood from preliminaries of leukocyte formulas, biochemical analysis of blood: blood cells, albumin, sechovina, creatine, alaninaminotransferase (ALT), aspartate dosage of blood cells (ATP), blood cells
2.4 Instrumental diagnostics
2.5 Experimental and psychological diagnostics
Symptom Check List-90 Revised (SCL-90-R); The Beck Anxiety Inventory (BAI); The Hamilton Anxiety Rating. ; Spilberger's anxiety scale (State-Trait Anxiety Inventory - STAI); Integrated anxiety test (ITT); Shihan's anxiety scale (ShARS), GAD screening scale).
It is recommended to use a methodology for the psychological structure of a specialty (Standardization of a clinical specialty MMPI expert (adaptations by I.M. Gilyasheva, L.N.Sobchik and T.L. Amona (ISTA), I. Burbil (2003)).
It is recommended to use victorious methods for the improvement of individual psychological characteristics of specialness (Methodology for the identification of the level of subjective control of specialness (USC); Opituvalnik for the development of specialties of the individual "Personal Beliefs Test", A. Bergernaya, 1984) scale of perfectionism (Multidimensional perfectionism scale - MPS)).
It is recommended to use methods for psychological diagnostics of factors in the development of mental maladjustment (Methodology "Life style index"; Method E. Heim (1988) for determining the character of copying behavior; Methodology to adapt to behavior); decision making questionnaire, - MDMQ).
It is recommended to use victorious methods for the psychological diagnosis of systems and significant problems (Inventory of Interpersonal Problems (IIP); Methodology for the diagnosis of intrapersonal, conflagration.
2.6 Differential diagnosis
GTR is necessary to differentiate with the upcoming distributions:
Social phobia;
Specific phobia;
Obsessive-compulsive disorder;
Post-traumatic stress disorder;
Panichny razlad;
Affective mood disorder (endogenous depression, recurrent depression disorder, bipolar disorder, dysthymia);
Somatoform rozladi;
Schizophrenia (paranoid, confident), schizotypal discord;
Rozladi osobistі (іsterichne, anankastny, trivial, emotsіyno-labіlny);
Residual-organic brain injury;
Organizational discomfort in the brain;
Gipotalamichne rozlad;
Pathology of the thyroid gland;
pheochromocytoma;
Implantation of psychoactive speeches (for example, Amphetamіnіv, kokainu and іn.);
Canning benzodiazepiniv.
3. Likuvannya
3.1 Conservative treatment
3.1.1 Psychopharmacotherapy
In the form of preparations in the first line, it is important to recommend selective antioxidants of serotonin (SIZZS) (paroxetine **, escitalopram #, sertralin ** #) and selective antioxidant antioxidants The efficacy of tricyclic antidepressants (clomipramine ** #) has been delivered.
The anxiolytic effect of pregabaline is approved **, it is infused with the psychic, somatic and vegetative components of the anxiety, as well as the tolerance and high level of safety is also safe. Yoga practice is recommended for GAD.
It is recommended to use short-term benzodiazepin (diazepam ** #, lorazepam **, phenazepam ** #). Trivalіst zastosuvannya obmezhuєtsya znachuschimi nebazhanimi efekta - sedation, znizhennyam kontsentratsії uwagi i zapam'yatovuvannya, psychomotor funktsіy torn down, rizik formuvannya zalezhnostі, virazheny vіdmіni syndrome scho viyavlyaєtsya pogіrshennyam i will posilennyam trivogi pіslya pripinennya priyah i obmezhuvatisya guilty to short courses (not bіlshe 2- 3 types).
The triviality of the therapy of generalized anxiety is recommended - not less than 6 months for a therapeutic effect in the form of concomitant therapy, protest in a large number of additional trials for a longer period of time.
Possible side effects of psychopharmacotherapy of generalized anxiety disorder. In case of stagnation of psychotropic drugs, it is recommended to take the onset of side effects: drowsiness, dullness, overwhelm, constipation or carry, tediousness, headache, zamorochennya. At the same hour, adequate admission and recognition of the reactions is strictly behind the indications to significantly reduce the risk to the manifestation of side effects.
An assessment of the effectiveness and tolerability of therapy is recommended, which is carried out on days 7-14-28 of psychopharmacotherapy and once every 4 days until the end of the course of treatment. In case of intolerance or lack of efficacy, a correction is performed to dose or change the drug.
3.1.2 Psychotherapy
Prototype indications for psychotherapeutic treatment:
1) patients with an ostracho before self-criticism and a strong reliance on "zaprechennya" as a form of psychological zaistu;
2) children with lack of motivation to change;
3) patients with low interpersonal sensitivity;
4) children who cannot get through all the busy times;
5) children, who do not take part in the process of active verbalization and hearing, as a part of the group;
6) children, whose characterological peculiarities do not allow them to be constructively successful in a group and to become robotic criminals (as they constantly play their own emotional calls as psychological reactions, and not because of their seriousness
In the capacity of special types of rehabilitation, it is recommended that family, social and psychological, professional is recommended.
One of the important forms of rehabilitation visits is recommended for support psychotherapy, which can be carried out on an outpatient basis in the form of individual and group psychotherapy.
5. Prevention and dispensary caution
6. Dodatkova information, which is added to the overrun and the result of becoming ill
6.1 Factors (predictors) to accept a prolonged interruption
Main predictors of prolonged GAD overrun
Predictor of uninterrupted interruption of protracted forms |
premorbid minimal cerebral deficiency; right-handed type of functional cross-sectional asymmetry; emotsіyne nehtuvannya s side znachuschih osіb in batkіvskіy rodinі scho will only be sold to the biopsychosocial konstelyatsії scho pereshkodzhaє virіshennyu konflіktіv, pov'yazanih of nevdalim dosvіdom rannіh vіdnosin, іntegratsії new dosvіdu, formuvannya stіykoї samootsіnki i viznachalnoyu znizhennya adaptatsіynogo potentsіalu osobistostі |
Predictor of the overbearing of lingering forms |
special features of an individual, so that they start to be different to stressful infusions, as they take on the most significant particularities and may have a more (stereotypical) character |
Psychological predictors of prolonged interruption |
victorious psychologic zhistu viglyadi vitisnennya; іnternіlіst in the posed to the ailment; a big breakdown of narcissistic regulation, to form instability in self-assessment, to a high degree of disagreement to criticism, I will vibrate with respect to a short notice; it is difficult to induce mischievous attitudes, which are manifested either by unique contacts, or by the poke of paternalistic attitudes, in order to avoid the appearance of a positive self-assessment |
Social predictors of prolonged interruption |
vikhovannya mother-single, separation / separation of fathers, disharmony of common denominations in the fatherland of Batkiv, in view of the special significance of family problems in sick people with chronic protracted interruption of neurotic disorders |
Criteria for assessing the quality of medical aid
criteria of quality
Equivalent evidence
Diagnosis stage
Viconano oglyad lykarem-psychiatr
Viconana assessed the risk of suicidal behavior
Viconano experimental psychology
Viconano analysis of blood biochemistry zagaltherapy (zagalnye billock, albumin, sechovina, creatinein, alaninaminotransferase, aspartate aminotransferase, bilirubin, dosage electrolyte blood, blood sodium
Viconano analiz sech zagalny
Viconano value thyroid stimulating hormone and triiodothyronine and thyroxine
viconana electroencephalography
Viconana transcranial dopplerography
Viconana Electrocardiography
stage likuvannya
Viconano the sign of psychopharmacotherapy
psychotherapy performed
The assessment of the effectiveness and tolerability of the prescribed therapy (on the 7-14-28th day and long distance)
Viconan change of therapy in case of daily efficiency or intolerance to therapy
Decrease in indicators of somatic anxiety for the Hamilton scale of triviality is reached
Decrease in indicators of mental anxiety for the Hamilton scale is reached
Reached the increase in the variety of psychopathological appears at the SCL-90 scale not less, not in the middle stage
List of Literature
Erichev A.N., Morgunova A.M. The current stressful situations and the warnings are somewhat troublesome. The yak is about to fight. / Practical guide. SPb.: Ed. hut. SPb MAPO, 2009 .-- 30 p.
Zalutska N.M. Generalization of anxiety disorders: modern theoretical models and approach to diagnostics and therapy. Part 1. / Review of psychiatry and medical psychology. - 2014 rock - No. 3 - pp. 80-89.
Karavaєva T.A., Vasil'va A.V., Poltorak S.V., Chehlatiy I.I., Lukoshkina .P. Criteria that algorithm for diagnostics of generalized troublesome breakdown. / Review of psychiatry and medical psychology im. V.M. Ankylosing spondylitis. - 2015. - No. 3. - S. 124-130.
Kotsyubinskiy A.P., Sheinina N.S., Butoma B.G., Erichev A.N., Melnikova Yu.V., Savrasov R.G. Holistic diagnostics in psychiatry. Occasionally 1. / Social Clinical Psychiatry. - 2013 - T. 23.- No. 4 - p.45-50.
Churkin A.A. The results of the epidemiological pre-development of the GTR wideness in the middle of the population of the great industrial city. Read more on the experimental diet for diagnostics and therapy of GAD 03/25/2010.
Andlin-Sobocki P., Wittchen H-U Cost of anxiety disordes in Europe. - Eur. J. Neurol., 2005; 12: 9-44.
Behar, E., Borkovec, T.D. (2005). The nature and treatment of generalized anxiety disorder. In: B.O. Rothbaum (Ed.), The nature and treatment of pathological anxiety: essays in honor of Edna B. Foa (pp. 181-196). New York: Guilford.
Borkovec, T.D., Inz, J. (1990). The nature of worry in generalized anxiety disorder /. Behavior Research and Therapy 28,153-158.
Bruce S.E., Yonkers K.A., Otto M.W. Influense of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia and panic disorder: 12-year prospective study. Am. J. Psychiatry, 2005, 62, p. 1179-1187.
Diefenbach, G. J., Stanley, M. A. Beck, J. G. (2001). Worry content reported by older adults with and without generalized anxiety disorder. Aging and Mental Health, 5, 269-274.
Eng, W., Heimberg, R. G. (2006). Interpersonal correlates of generalized anxiety disorder: self versus other perception. Anxiety Disorders, 20, 380-387.
Hoehn-Saric, M. D., McLeod, D. R., Funderburk, F. Kowalski, P. (2004). Somatic symptoms and physiologic responses in generalized anxiety disorder and panic disorder. An ambulatory monitor study. Archives of General Psychiatry, 61, 913-921.
Holaway, R. M., Rodebaugh, T. L., Heimberg, R. G. (2006). The epidemiology of worry and generalized anxiety disorder. In G.C.L. Davey, A. Wells (Egs.), Worry and its psychological disorder: Theory, assessment and treatment (pp. 3-20). Chichester: Wiley.
Lieb R., Becker E., Almatura C. The epidemiology of generalized anxiety disorder in Europe. European Neuropsychopharmacology, (15) 2005, pp. 445-452.
Mennin, D. S., Heimberg, R. G., Turk, C. L., Fresco, D. M. (2005). Preliminary evidence for an emotion dysregulation model of generalized anxiety disorder. Behavior Research and Therapy 43,1281-1310.
Romera I, Furnandez-Purez S, Montego BL, Caballero L, Arbesu JB, Delgado-Cohen H. Generalized anxiety disorder, with or without co-morbid major depressive disorder, in primary care: prevalence of painful somatic symptoms, functioning and health status ... J Affect Disord 2010 rock; 127: 160e8.
Turk C. L., Heimberg R. G., Luterek J. A., Mennin D. S., Fresco, D. M. (2005). Emotion dysregulation in generalized anxiety disorder: a comparison with social anxiety disorder. Cognitive Therapy and Research, 29, 89-106.
Wittchen H-U., Kessler RC., Beesdo K., Krause P., Hofler M., Hoyer J. Generalized anxiety disorder and depression in primary care: prevalence, recognition, and management. J. Clin. Psychiatry 2002 63 (suppl. 8), p. 24-34.
Wittchen H-U. Generalized anxiety disorder: prevalence, burden, and cost to society, Depress. Anxiety, 2002; 16: 162-171.
Yonkers K. A., Dyck I. R., Warshaw M. G. Keller M. B. (2000). Factors predicting the clinical course of generalized anxiety disorder. British Journal of Psychiatry, 176, 544-549.
Dodatok A1. Working group warehouse
- Vasil'va Ganna Volodimirivna - Doctor of Medical Sciences, Associate Professor, Provincial Scientist in the Department of Psychological Disorders and Psychotherapy of the Federal State Budgetary Institution "St. Petersburg Scientific and Historical Psychoneurological Institute V.M. Bekhterev "Ministry of Health of the Russian Federation.
- Karavaєva Tetyana Arturivna - Doctor of Medical Sciences, Associate Professor, Head of the Scientific Spivrobotnik, Head of the Department of Psychological Disorders and Psychotherapy of the Federal State Budgetary Institution “St. V.M. Bekhterev "Ministry of Health of the Russian Federation.
- Mizinova Olena Borisivna - Candidate of Psychological Sciences, Senior Scientist in the Department of Psychological Disorders and Psychotherapy of the Federal State Budgetary Establishment “St. V.M. Bekhterev "Ministry of Health of the Russian Federation.
- Poltorak Stanislav Valeriyovich - Candidate of Medical Sciences, Provincial Scientist in the Study of Near-Cordon Psychological Disorders and Psychotherapy of the Federal State Budgetary Institution “St. V.M. Bekhterev "Ministry of Health of the Russian Federation.
- Bukrva ND, Doctor of Medical Sciences, Curriculum Vitae of the Scientific Organizational Department of the Federal State Budgetary Institution “FMITSPN im. VP Serbskiy ";
- Rakityanskaya E.A., Candidate of Medical Sciences, Senior Scientist in Science of the Scientific Organizational Department of the Federal State Budgetary Institution "FMITSPN IM. VP Serbskiy ";
- Kutuєvo R.V., a young scientist in science at the Scientific Organizational Department of the Federal State Budgetary Institution “FMITSPN im. VP Serbskiy ".
Conflict of interests Відсутнє.
- Likari-psychiatri
- Likari-psychotherapy
- Clinical psychologists
- Lіkarі for outbound profile
Table P1- Equivalent evidence
reliability |
dzherelo proof |
Prospective randomized control of pre-release (PCI) A sufficient number of children with a sufficient effort, for the part of a great number of children and for the rejection of a great number of divers Great meta-analyzes Yak minimum one kindly organized by RSI Representative vibration of patients |
|
Prospective with randomization, but without further advancement with an interconnected number of tributes Kilka doslidzhen with a small number of children Well-organized prospective cohorts Meta-analysis of intercourse, if carried out on a good basis The results are not representative of the whole population Good organization of the "vipadok-control" |
|
Non-randomized control over the past Prescribed lack of control РСІ s yak minimum 1 digit or yak minimum 3 insignificant methodological pardons Retrospectives and glances A series of key words Superb data, but I do not allow you to formulate a residual recommendation |
|
Expert's thought / data from the expert committee's opinion, experimentally approved and theoretically grounded |
Table P2- Equivalent confusion of recommendations
rivn overconfidence |
to describe |
decryption |
Method / therapy of the first line; or in the presence of a standard technique / therapy |
||
Method / therapy of another line; or if there is a contraindication, or if the standard technique / therapy is ineffective. It is recommended to monitor the disease |
||
Numerous overconfused tributes (ni about cinnamon, ni about risik) |
There is no list against the given method / therapy and not a list against the continuation of the given method / therapy |
|
The visibility of overconfused publications I, II or III level of proof, how to show the value of the corysti over the rizik, or overconfusion of the publications I, II or the III level of proof, how to show the value of the corysti over the rhizik |
Dodatok A3. linking documents
Order No. 1225n "About the hardened standard of primary medical and social assistance for neurotic, stress-related and somatoform disorders, generalized anxiety disorders in the outpatient minds of the neuropsychiatric dispensary.
Order No. 1229n "On the hardened standard of special medical aid for neurotic, stress-related and somatoform disorders, generalized anxiety disorders" issued on 20.12.2012.
Dodatok B. Algorithms for patient management
Algorithm for conducting patients with generalized tripping
Dodatok V. Information for patients
What are the same troublesome things?
Troubled troubles are a group of nervous system malaise, the main manifestation of which there is a sense of troubles, which are diagnosed for no reason, for whatever reasons.
What are the main symptoms of anxiety disorders?
Not primed for feeling triviality, difficulty in behavior, confusion, fear of death or an inevitable catastrophe, pounding in the breasts or in the stomach, seeing a "ball in the throat" and in.
Diagnostics of three-way breakdowns.
Call the diagnosis of anxiety disorders to arise when all ailments are turned on, when there may be similar symptoms. The diagnosis and treatment of anxiety disorders and panic attacks are dealt with by a psychotherapist, psychiatrist.
An early diagnosis can be made by a doctor of foreign practice, a neuropathologist.
Lіkuvannya tricky stanіv.
The treatment of anxiety disorders includes psychotherapy and the sign of drugs, which can help reduce some troubles (anxiolytics).
Psychotherapy includes developmental techniques to help a sick person with anxiety problems correctly assess the situation, until they are relaxed before an hour of anxiety attacks. Psychotherapy can be carried out individually or in small groups. Adopting the rules of behavior in different situations to help you to feel better in your own power to fit in with stressful situations.
Likarske lіkuvannya of troublesome disassembly includes the storage of young zasobіv, which is poured into the light. Likas, which are somewhat trivial, are called anxiolytics. Medication for treatment is a sign, correction of therapy, treatment of drugs in a person's health.
Dodatok G.
Instructions. At the bottom, a reversal of problems і skarg, іnіkayut people. Be affectionate, read the skin paragraph respectfully. Draw a circle around the number of that type, which will accurately describe the steps of your discomfort or shyness in connection with this problem of the last time, including the current day. Circle only one of the numbers in the skin point (for example, the number in the middle of the skin rim is visible), not skipping the point. If you want to change your name, fix your first sign.
PIB __________________________________ Date ____________________
We've got a lot of turbulence for you: |
zovsim |
trochus |
alongside |
strongly |
even strongly |
1.Headache pain |
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2.Nervousness or internal tremor |
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3. Repetitive inappropriate thoughts |
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4.weakness or mess |
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5.Loss of sexual desire or satisfaction |
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6) feeling unhappy with others |
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7.Feeling that you can cheruvati with your thoughts |
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8. The feeling that all your disabilities are more likely to blame |
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9 problems with memory |
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10.Your lack of balance or lack of integrity |
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11.It's easy to win |
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12 pain in the heart or chest pains |
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13. Feelings of fear in extreme scenes or on the streets |
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14. The decline of forces is a matter of being galvanized |
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15.Misli about those who put their hands on themselves |
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18. Feeling that more people can do it |
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19 poor appetite |
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20.Tearfulness |
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21. Shyness or mobility in spilkuvanny with persons of antiquated stati |
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22. The feeling of being in the pastry or feeling |
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23 Unexpected or Unreasonable Fear |
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24.Lists of nausea, as they could not stream |
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25. Fear of going home alone |
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26. Feeling that you are rich in yourself |
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27 Pain across |
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28. The sensation that you are going to get started. |
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29. A sense of self-reliance |
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30 suppressed mood, blues |
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31. Excessive retention of the drive |
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32 Lack of interest in anything |
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33. Feeling fear |
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34.That's what yours seems to be easy to grab |
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35. The feeling of getting into your thoughts |
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36. Feeling that you do not understand you, but that they support you |
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37. Feeling that people are unfriendly or not befitting |
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38. The need to work more and more often, so do not allow pardon |
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39. Strong or quickened heart |
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40.Nausea or disgusting slunk |
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41. Feeling that you are better than others |
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42 pain in myaz |
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43. The feeling that others are spontaneous behind you, for talking about you |
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44) It’s important for you to fall asleep |
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45. The need to overturn or overturn those that you are |
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46. Difficulties in Accepting Solutions |
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47 fear of driving on buses |
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48. Difficulty dikhannya |
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49. Step of spec or chills |
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50. Necessity of unique deyakyh mіsts abo dіy, so how to stink you |
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51. So, you can easily use the thought |
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52.Onemenie abo pokolyuvannya in the small parts of the house |
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53. Lump in the throat |
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54. The feeling of being hopeless |
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55.That, it is important for you to zosereditsya |
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56 Feeling of weakness in the small parts of the body |
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57. Feeling of tension or tension |
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58. Severity in pictures |
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59.Miss about death |
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60. Overeating |
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61 Feeling unhappy when people try to follow you |
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62.That's what you have in someone else's mind |
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63.Impulse zapod_yuvati t_lesnі ear |
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64 Sleeplessness |
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65. The need for repetition of diy: torquess, mitisya, perekhovuvati |
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66. Restless and restless sleep |
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67.Impulse lamati |
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68. You have an idea or a verdict, as it does not match those |
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69. Excessive litter 'persistence when splitting with children |
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70 Feeling unhappy in crowded places (shops, cinemas) |
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71. Feeling that everything, you didn’t get intimidated, vimagaє of the great Zusil |
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72. Step zhahu abo paniki |
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73. Feeling unhappy when you are in public |
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74.Sho vi often join the super-list |
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75. Nervousness when you are alone |
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76.That's what you underestimate your achievement |
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77. A sense of self-reliance, to be welcomed if you are with other people |
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78.So much more distressing than we couldn’t go to the mission |
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79. Feeling of powerlessness |
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80. Feeling that you are going to become nasty |
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81.To, scho vi shout or burst with speeches |
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82 Fear of losing your testimony in public |
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83. The feeling that people are evil with your trust, if you allow me |
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84. Sexual Thoughts That Nerve You |
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85.Misl about those who are guilty buty punish for your sins |
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86. Nightmare dumka abo bachennya |
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87. Mistakes about those who are out of order with your business |
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88. That you don't see anyone's closeness |
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89. Feeling Guilty |
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90. Mistakes about those, that with your mind there is unkindness |
The key to the technique
Somatization SOM (12 points) - 1 4 12 27 40 42 48 49 52 53 56 58
Obsessive-compulsive O-C (10 points) - 3 9 10 28 38 45 46 51 55 65
Missociality INT (9 points) - 6 21 34 36 37 41 61 69 73
Depression DEP (13 points) - 14 15 20 22 26 29 30 31 32 54 56 71 79
Triviality ANX (10 points) - 2 17 23 33 39 57 72 78 80 86
HOS value (6 points) - 11 24 63 67 74 81
Phobias PHOB (7 points) - 13 25 47 50 70 75 82
Paranoid PAR (6 points) - 8 18 43 68 76 83
Psychoticism PSY (10 points) - 7 16 35 62 77 84 85 87 88 90
Additional points Dopoln (7 points) - 19 44 59 60 64 66 89
Processing from the Rimanih Danih
- Bali for the skin scale - 9 indicators. The sum of points for the skin scale is divided into a number of points in the whole scale. For example, the sum of points on the 1st scale is 12, on the 2nd - by 10, etc.
- The grand ball is the GSI (General Symptomatical Index). I will return the sum of all points to the amount of 90 (up to points in the expert).
- Positive Symptomatical Index (PSI). There are a number of items, for which an estimate is given from 1 to 4.
- PDSI (Positive Distress Symptomatical Index). The GSI index multiplied by 90 and the divisions by the PSI index.
describe scales
- Somatization. The items included in the scale represent distress, which is the result of learning the deterioration of the functions of the body. The parameter includes skargi for the heart-vascular, shlunkov-gut, dichal and іnshі systems. In the case of an organic basis of scarg, flexible somatoforms and equivalents of trivialities are reestablished.
- Obsessive-Compulsive. The core of the central scale is the same clinical syndrome. Including the points about the repetition and lack of importance of singing phenomena, as well as the appearance of more distant learning difficulties.
- Interpersonal Sensitivity. Symptoms, which form the basis of the whole scale, are perceived to be especially inadequate and inconsistent in social contacts. The scale includes points that represent self-condemnation, feeling the lack of discomfort and discomfort during interdisciplinary intercourse. Imagining smartness to reflexion and underestimating self-assessment.
- Depression. The points, which are referred to the scale of depression, represent a wide number of conditions, which are supervising the main depression syndrome. The inclusion of skargi for the sale of interest to efficiency, lack of motivation and waste of life energy. The scale also includes points related to the idea of suicide, to the feeling of hopelessness, marnosity, and other somatic and educational characteristics of depression.
- Anxiety. A group of symptoms and reactions is considered to be on the scale, as you call it clinically to ring with an obvious (obvious) tricky leg, which feels like a harsh, causeless, internal restlessness. The basis of the scale є skargi for the perception of nervousness, impatience and internal stress in common with somatic, motor manifestations.
- Anger-Hostility. The Danish parameter is formed from three categories of divine behavior: thoughts, feelings and ideas.
- Phobic Anxiety. Skargi, who enter the whole scale, visualize fears, tied with high roads, open spaces, huge places, transport and phobic reactions of a social nature.
- Paranoid Ideation. When the given scale L.R. Derogatis s spivavt. You got used to the positions that paranoid appearances can be more beautifully touched when they are missed. Draw a paranoid misrepresentation, which may be of the first order of importance, within the framework of being imposed by an expert, boules are included in the scale. Tse, persh for everything projecting the target, the fortune, the sentiment, the ideas of the day.
- Psychoticism. The basis of the scale is such symptoms: rumors of hallucinations, transfer of thoughts to the office, calling of management of thoughts and intrusion of thoughts of calls. The order of the points, in the opytuvalnik, are presented and indirect signs of psychotic behavior, as well as symptoms that can influence the schizoid way of life.
Dodatok G2. Hamilton scale for assessing triviality
Instructions and text
Determination of the test 20 - 30 chilins, holding out as the experimenter will see the test according to the topic of nutrition and assessed on a five-point scale.
- Anxious mood (obsession, deception of the best, anxious fight, gratitude).
- Відсутнє.
- In small doses.
- At the pomirnom step.
- In a difficult step.
- At a very important step.
- Nagging (seeing naprugi, zdrigannya, easily getting crying, tremulous, feeling uncomfortable, unrepentant growth).
- Відсутнє.
- In small doses.
- At the pomirnom step.
- In a difficult step.
- At a very important step.
- Fears (fear of temryavi, do not know people, creatures, transport, NATO, fear of becoming alone).
- Відсутнє.
- In small doses.
- At the pomirnom step.
- In a difficult step.
- At a very important step.
- Insomnia (it’s not difficult to sleep, distracted sleep, but not to bring an awakening sleep because of weakness and weakness during awakening, nightmares).
- Відсутнє.
- In small doses.
- At the pomirnom step.
- In a difficult step.
- At a very important step.
- Intellectual destruction (the concentration of respect, the destruction of memory is complicated).
- Відсутнє.
- In small doses.
- At the pomirnom step.
- In a difficult step.
- At a very important step.
- Depressive mood (waste of vivid interests, waste of satisfaction from hobbies, attrition, early awakening, I will add more interest).
- Відсутнє.
- In small doses.
- At the pomirnom step.
- In a difficult step.
- At a very important step.
- Somatic symptoms (bile, myazovy posmikuvannya, napruga, myoclonic sudomy, "creaking" teeth, a voice is seen, myazovy tone tone).
- Відсутнє.
- In small doses.
- At the pomirnom step.
- In a difficult step.
- At a very important step.
- Somatic symptoms (sensory - dzvin in wuhah, unclearness of the light, pour in the heat or the cold, feeling weakness, seeing pokryuvannya).
- Відсутнє.
- In small doses.
- At the pomirnom step.
- In a difficult step.
- At a very important step.
- Heart-and-heart symptoms (tachycardia, heart disease, chest pain, pulsation in the chest, feeling weakness, part of the disease, dyspnea).
- Відсутнє.
- In small doses.
- At the pomirnom step.
- In a difficult step.
- At a very important step.
- Respiratory symptoms (feeling the grip of abnormal breast cancer, Vidchuttya odors, parts of zithannya, dyspnoea).
- Відсутнє.
- In small doses.
- At the pomirnom step.
- In a difficult step.
- At a very important step.
- Gastrointestinal symptoms (obstruction, flatulence, abdominal pain, stove, feeling of replenishment of the slunk, nausea, bloating, gurgling in the stomach, diarrhea, decreased vaginal til, constipation).
- Відсутнє.
- In small doses.
- At the pomirnom step.
- In a difficult step.
- At a very important step.
- Sechostatic symptoms (often secular, severe positive for secular, amenorrhea, menorrhagia, frigidity, early ejaculation, loss of libido, empathy).
- Відсутнє.
- In small doses.
- At the pomirnom step.
- In a difficult step.
- At a very important step.
- Vegetative symptoms (dryness in the mouth, dryness shkіrnykh pokrivіv, Blindness of small crooks, due to the appearance of problems, headache with the appearance of springs).
- Відсутнє.
- In small doses.
- At the pomirnom step.
- In a difficult step.
- At a very important step.
- Behavior when looking around (fidgeting at the scene, restless gestures or movements, tremors of the hands, frowning of bruises, strains of conviction, excitement or acceleration of excitement, bliss of accusation, part of the conversation).
- Відсутнє.
- In small doses.
- At the pomirnom step.
- In a difficult step.
- At a very important step.
Anxious mood - Problem, deception of the best, anxious fight, gratitude.
spins - Seeing naprugi, zdrigannya, easily winy crying, tremulous, seeing unconsciousness, lack of relaxation.
Fears - Fear of temryavi, not knowing people, creatures, transport, NATO, fear of becoming alone.
Insomnia - It is not difficult to get sleepy, distracted sleep, but not to bring an end to sleep because of the weakness and weakness during awakening, nightmares .
Intellectual destruction - Difficult concentration of respect, destruction of memory.
Depressive mood - The waste of winter interests, the waste of the satisfaction of the good, the welcome, the early awakening, and the more I will become.
Somatic symptoms (myazov) - Pain, myazovy posmikuvannya, napruga, myoclonic sudomi, "gritting" teeth, to see the voice, movement of myazovy tone.
Somatic symptoms (sensory) - Dzvin in wuhah, unclear zoru, pour in the heat or the cold, seeing weakness, seeing pokryuvannya.
Heart-and-heart symptoms - Tachycardia, heart disease, chest pain, pulsation in the chest, feeling weakness, part of the disease, dyspnea.
Respiratory symptoms - Feel the grip of abnormal squeezing of the breast, smell of breath, part of the disease, dyspnea.
Gastrointestinal symptoms - Difficulty working out, flatulence, pain in the abdomen, in the presence of overfilling of the slunk, nudity, bloating, gurgling in the stomach, diarrhea, decreased vaginitis, constipation.
Sechostatic symptoms - Accelerated secular depression, strong positive for secular depression, amenorrhea, menorrhagia, frigidity, early ejaculation, loss of libido, empathy.
Vegetative symptoms - dryness in the mouth, withering of withers, wobbling of withers, increase in sweatiness, headaches with frustration.
Behavior when looking around - fidgeting at the scene, restless gesticulation about the move, tremor of the hands, frowning of bruises, picking up the face of revealing, retarding or speeding up the action, the blunder of accusation, part of the fight
Processing from the Rimanih Danih
Opituvalnik of motives by such a rank, for a number of points to be so called "somatic triviality", according to seven - "psychic trivoga".
Interpretation
0-7 - the visibility of the tricycle;
8-19 - symptoms of anxiety;
20 і vishche - an anxious camp;
25-27 - panichny breakout.
With such a rank, the sum of scores as a result of the assessment of individuals, who do not suffer from the trivial, is close to zero. The most energetic ballroom is 56, which shows the extreme steps of the turn of the anxious camp.
Dodatok G3. Recommended dosage of drugs, level of evidence and strength of recommendations for treatment of GAD
level of proof |
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paroxetine ** |
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escitalopram # |
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Sertralin ** ## |
|||
Fluoxetine ** # |
|||
citalopram # |
|||
venlafaxine # |
|||
Duloxetine # |
|||
Інші groups of antidepressants |
|||
Klomipramin ** # |
|||
Amitriptyline ** # |
|||
Klomipramil |
|||
mirtazapin # |
|||
trazadone # |
|||
benzodiazepini |
|||
Diazepam ** # |
|||
lorazepam ** |
|||
Bro** # |
|||
nitrazepam ** |
|||
alprazolam |
|||
non-benzodiazepinovium cochty |
|||
hydroxyzine ** |
|||
Zopiklon ** # |
|||
buspiron |
|||
Etifoxin |
|||
antipsychotics |
|||
kvetiapin # |
|||
Chlorprotexene |
|||
clozapine # |
|||
thioridazine ** |
|||
Sulpiride ** # |
|||
antiepileptic drugs |
|||
pregabalin ** |
Generalized anxiety disorder(Basis), I’m on the point of being generalized, chronically tricky, to enter the same troublesome situation, for example, it’s anxiety-depressive, socially-troublesome and the most troublesome.
Symptoms of generalized anxiety disorder (GAD)
Disorder (GAD) generalized anxiety disorder is possible for the following symptoms and criteria:- Zayva trivogo і still with nasty perechutty, which trivia not less than pіvroku і appear more often today. The tsia is pidvischenny anxiety may be tied with some kind of podіy in the life of people and from their dіyalnіstu (robot, navchannya ...)
At the same time, Lyudin may not be able to control his trivia.
- The triviality of the people is tied with several symptoms:
- Rukhovo zbudzhennya і stan unimportance;
- Easy stomachability;
- It is important to concentrate respect, і zapam'yatovuvati;
- gratitude;
- Strength of m'yaziv;
- Rozlad to sleep.
- Those, on which the generalized trivia is concentrated, do not fall on the ground:
Likuvannya generalized tricky breakdown
The key peculiarity of the GTR is that it is overwhelming, not being controlled by the current state of affairs. To that, the generalization of the generalized troublesome disposition is not only aimed at usuning troubled troubles, but rather at controlling over the past.The drug therapy of GAD does not give serious results in the future, before that, many pharmaceuticals are produced to the extent of stagnation and other side effects.
For the best i effective method treatment of anxiety and lateness (GAD) є cognitive and behavioral psychotherapy and transactional analysis, with psychological rights and social training, including relaxation of self-hypnosis.
You can go through psychotherapy individually or in a small group (up to 8-10 cholas), the triviality of an individual session is 1 year, and 1-2 psychotherapeutic sessions per week. Allow for relief from generalized troublesome distribution, required from 10 to 20 regular sessions, in the absence of psycho-physiological individuality of people, and also to make it difficult to break up.
Even if people hold out to the pivrok, they are more likely to feel overwhelmed by the feeling of restlessness and anxiety, we can talk about generalized anxiety disorder (GTR).
The reasons for the generalized troublesome breakdown
Exact reasons for the development of ill health. It is not often possible to learn from patients who suffer from alcoholic debris, as well as from attacks of panics and important depressions.
Dane getting sick є let us expand. Zgіdno zі statistiki, chorіchno fall ill close to 3% of the population of the planet. Moreover, women are sick twice as often, below the number of people. Often it is possible to develop an affliction among children and children, or to generalize anxiety disorders and among grown-ups.
Zagvoryuvannya is characterized by a persistent triviality and belligerence, which can be seen from the drive of old furnishings, for example, since it is clearly not possible to win over such hvilyuvannyas. Students, for example, can have an overwhelming fear of sleepwalking, and moreover, if they have good knowledge and high assessments, they can feel it. Ailments with GAD often do not grasp the overwhelming fears of their fears, but they are constantly worried about their discomfort.
It may be possible to diagnose GAD, and symptoms of guilt appear in a stretch, like a minimum, six months, and the triviality is guilty of being uncontrolled.
Symptoms of generalized anxiety disorder
With GAD, a bezposeredn_y drive for triviality does not appear clearly, as in case of early panic attacks. The patient can be sick for no reason. The most frequent trips are the drive of professional crops, the continuous failure of pennies, safety, health, the repair of the machine or any other equipment.
Typical symptoms of generalized anxiety disorder є: increased stomatism, unconsciousness, dreadfulness, weakened concentration of respect, impaired sleep, sponginess. It means that there are more patients from the GTR, but there are also more psychotic problems, including a panic disorder, a depressive or social phobia, etc.
Clinically, the GTR is manifested by an offensive rank: the patient sees a post-trivial struggle and springs, a wicked low situation, for six or more months. Tse an anxiety stun can not be controlled, and supervise overwhelming symptoms.
For the diagnosis of GAD in children, they want one to six symptoms. For the diagnosis of generalized anxiety disorder in older adults, it is necessary to have a minimum of three symptoms.
With GAD, restlessness and anxiety are not interlaced with motives, which are characteristic of the other anxious troubles. So, late and trouble is not tied solely to the acute panic attacks (panic disagreement), the fear of the great purchase of the people (social phobia), the wives (nervous anorexia), the fear of being thrown into the child (іpochondria) and іnshі. The patient's anxiety-ridden wickedness has discomfort and prompts him to lead a new life.
As a rule, the symptoms of generalized anxiety disorders of low physical disorders (for example, hypothyroidism), as well as taking drug abnormal drugs.
Riziku factories
The chances of seizing the GTR will increase with the appearance of offensive officials:
- become a zhіnoch;
- low self-assessment;
- schism to stress;
- smoking, implantation of alcohol, drugs, or drugs, so that there is no deposit;
- trivial transfer of one or more negative factors (violence, violence, etc.);
- the presence of members of the family of troublesome problems.
Diagnostics of generalized anxiety breakdown
At the consultation, the doctor viroblyas physical examination of the patient, feeding him about the history and symptoms of illness. Diagnostics of ailment includes the carrying out of pre-diagnostics for the detection of other ailments, which could provoke a GAD (for example, a disease of the thyroid gland).
Likar will feed the patient, as well as medications for taking drugs, so as some of them can suffer serious side effects, similar to the symptoms of GAD. Also, the doctor obov'yazkovo pokavitsya, a fallen patient from tyutyun, alcohol or narcotic speech.
An accurate diagnosis of GAD can be established when offensive officials are present:
- Symptoms of GAD are more than a stretch;
- the stench wicks the sickly discomfort in the patient and make him feel better about life (for example, the patient of the temptations to miss a visit to the robot);
- GAD symptoms are persistent and uncontrolled.
Likuvannya generalized tricky breakdown
As a rule, the generalization of the generalized troublesome distribution is based on the advanced methods:
Likarski zasobi for lіkuvannya generalized tricky roslade include:
- Benzodiazepines, which take the weakening of the connections and switch them to the point of view on troublesome thoughts. The goal is to be taken under the control of the doctor, so that it can be damaged.
- Preparations for the reduction of anxiety, such as Buspiron, Alprazolam;
- Antidepressant (also important for the ingestion of the vermicular entrapment of serotonin).
- Beta blockers for symptoms of GAD.
For the most distant love of the GTR, it is important to find the disease earlier, as it will allow changing the risk of important psychological problems.
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