ПРОБЛЕМНЫЕ ВОПРОСЫ ДИАГНОСТИКИ И ТЕРАПИИ НЕПСИХОТИЧЕСКИХ ПСИХИЧЕСКИХ РАССТРОЙСТВ У ПАЦИЕНТОК КЛИМАКТЕРИЧЕСКОГО ВОЗРАСТА С ИСТЕРИЧЕСКИМ СИМПТОМОКОМПЛЕКСОМ (ОБЗОР ЛИТЕРАТУРЫ)

Abstract

In the article, problematic questions of diagnostics and therapy of non-psychotic mental disorders (NPMD) in female patients of climacteric age with hysterical symptom complex are considered. Efficacy of psychotherapy (PT) in NPMD, hypnopsychotherapy in hysterical states: hysterical neurosis, neurasthenia and obsessive-compulsive neurosis is indicated. In treatment of NPMD, PT by creative selfexpression is successfully used. It is highlighted that PT forms conscious-critical attitude of patients toward themselves. Combination of PT with physiotherapy in hysterical conversional symptoms has been described. In hysterical manifestations neuroleptics are recommended, in neurotic depressions – antidepressants of mild action. In severe hysterical state, psychopharmacotherapy (PPhT) with tranquilizers and neuroleptics is applied on long-term basis. Stable recovery in dissociative and hysterical disorders has been shown. In vegetovascular disorders in structure of climacteric syndrome (CS) vinpocetine, in psychoemotional manifestations phenibut was administered. In therapy of hysterical neurosis, “minor neuroleptics”, hypnosuggestive therapy, social rehabilitation were applied. Effective group PT of psychogenically conditioned disorders in asthenicand anxiety-depressive symptoms is effective. Complex therapy of NPMD in hysterical and asthenic neurosis, obsessive-compulsive neurosis has been suggested. Organization of specialized preventive examinations for early revealing of persons with personality pathology is based. Efficacy of a number of medications in periand post-menopause – SSRIs and gabapentin, during menopause paroxetine, in depressions of non-psychotic level – pyrazidol, coaxil, in neurotic hypochondriasis sulpiride and quetiapine, diazepam, in climacteric vegetative and mental disorders hormone replacement therapy (HRT), hormonal therapy, PPhT and PT, in neurovegetative symptoms of CS – antidepressants, in psychovegetative syndromes – SSRIs, in dysthymic disorders – tianeptine (coaxil), in involutional hysteria – psychotropic medications and medications of neurometabolic action, in psychoemotional disorders of mild and moderate degree – deprim, in depressive disorders of mild and mean severity – valdoxan has been shown. In climacteric depression, hormonal therapy stops climacteric symptoms.