Цитата:
|
Сообщение от yananshs
The correct answer is C. In acute psychiatric emergencies, a neuroleptic agent (haloperidol) and a benzodiazepine (diazepam) are typically given to control the patient and aid in sedation. An anticholinergic agent, such as benztropine, should be added to prevent parkinsonian-like symptoms (rigidity and akinesia) that may occur in patients treated with high-potency antipsychotic agents (haloperidol).
In this acute situation, it is inappropriate to begin psychosocial treatment with behavior skills training (choice A). Psychosocial treatment, including behavior skills training, multi-family groups, vocational training, and workshops, is very important in the long-term management of schizophrenia. During the patient's hospitalization, after the patient is stabilized, the treatment plan should focus on practical issues, and set the stage for outpatient psychosocial issues.
Dantrolene is the treatment for neuroleptic malignant syndrome (choice B), which may be caused by high-potency antipsychotic agents (haloperidol). It is not routinely given to prevent this condition. NMS is associated with a high fever, autonomic instability, rigidity, behavioral changes, and laboratory abnormalities such as elevated white blood cell count, creatine kinase, and abnormal liver function tests.
Clozapine (choice D) is used as a second-line antipsychotic agent for patients who do not respond to the typical antipsychotic medications and have prominent negative symptoms (flat affect, poverty of speech, and asociality). It is not typically the first agent given in an acute psychiatric emergency. It is associated with agranulocytosis (1%) and requires weekly monitoring of the white blood cell count.
Electroconvulsive therapy (choice E) may be used in cases of non-responsive catatonia. It is not often used to treat an acute psychiatric emergency with a wild and out of control patient.
|
Прошу прощения, что не вовремя, не хотела портить праздник непсихиатрам и прозевала
.
Так вот. В наших странах (до распада СССР, в России до сих пор) препаратом первого ряда, который назначается вместе с галоперидолом в первый же день, является циклодол. Препарат, к сожалению, попал в разряд учетных, однако в острой психиатрии он есть всегда. И еще немножко насчет ECT (ЭСТ). Не только при кататонии. Но и при резистентной к терапии шизофрении (кстати, и депрессии) вообще. Абсолютно точно то, что в качестве скорой помощи не применяется никогда.