1. Intenzivna psihijatrijska skrb – hitna stanja u psihijatriji
- Author
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Joško Prološčić, Sandra Blažević Zelić, Marija Vučić Peitl, and Ivana Ljubičić Bistrović
- Subjects
agressive behavior ,psychiatric emergencies ,psychiatric intensive care ,suicidal behavior ,agresivno ponašanje ,hitna stanja u psihijatriji ,psihijatrijska intenzivna skrb ,suicidalno ponašanje - Abstract
Intenzivna psihijatrijska skrb jest vrsta psihijatrijskog liječenja bolesnika koja se provodi na zatvorenom psihijatrijskom odjelu i po mogućnosti u jedinici intenzivnog liječenja, a sadržaji su joj dijagnostika, liječenje i opservacija hitnih stanja, odnosno bolesnika u psihijatriji. Uključuje sveobuhvatnu razinu skrbi, 24-satnu opservaciju te mogućnost fizičkog sputavanja i odvajanja bolesnika u slučaju gubitka kapaciteta za samokontrolu. Najčešća hitna stanja koja zahtijevaju intenzivnu psihijatrijsku skrb jesu suicidalnost, auto i hetero agresivnost i krizna stanja. Pregled bolesnika uključuje anamnezu, heteroanamnezu, opis psihijatrijskog statusa, opći somatski i neurološki pregled, laboratorijske pretrage, a ponekad CT i MRI mozga. U liječenju hitnog psihijatrijskog bolesnika upotrebljavaju se psihofarmakoterapija, psihoterapija (kratka, individualna dinamski orijentirana, ventilacija, debriefing, suportivna psihoterapija i obiteljska), te ponekad fizičko sputavanje i odvajanje bolesnika u izolacijsku prostoriju zbog moguće opasnosti za sebe i/ili okolinu. Članovi medicinskog tima su psihijatri te medicinske sestre i tehničari koji su stručno i posebno educirani u kliničkoj hitnoj psihijatriji i koji će odmah po prijamu bolesnika odrediti prioritete postupaka, dijagnostike i liječenja. Vrijeme provedeno u jedinici za intenzivnu psihijatrijsku skrb različito je, ali najčešće je od 2 do 6 dana. Po smirivanju akutne kliničke slike koja je i bila razlogom prijama u takvu jedinicu, bolesnika se premješta na odgovarajući psihijatrijski odjel sukladno njegovom općem psihofizičkom stanju i psihijatrijskoj dijagnozi. Iako se općenito misli da su postupci intenzivne psihijatrijske skrbi ponekad naglašeno specifični ili izvan okvira kompetencija osoblja koje radi u tim jedinicama, one su nužne i medicinski opravdane., Intensive psychiatric care is a type of psychiatric treatment of patients conducted in a closed psychiatric ward, and engages the diagnosis and treatment of psychiatric emergencies. Includes a comprehensive level of care, 24-hour observation, and the possibility of physical restraint and isolation of patients in the event of loss of capacity for self-control. Psychiatric disorders treated in such departments are deteriorating mental state within the various mental disorders. The most common emergencies that require intensive psychiatric care are suicide, auto and hetero aggressiveness and states of crisis. Examination of the patient includes medical history, heteroanamnesis, description of psychiatric status, general and neurological examination, laboratory tests, and sometimes CT and MRI of the brain. In order to take care of urgent psychiatric patients in use is pharmacotherapy, psychotherapy (brief, individual dynamically oriented, ventilation, debriefing, supportive and family psychotherapy), and sometimes physical restraint and isolation of patients in isolation room because of possible danger to himself and / or the environment. The principal members of the medical team are psychiatrists, nurses and technicians who are highly qualified and trained in clinical psychiatry emergency and will immediately determine procedure, diagnosis and treatment of the patient. Time spent in psychiatric intensive care unit varies, but is usually from 2-6 days. By calming the acute clinical picture which is the reason for admission to such department, the patient is transferred to other psychiatric wards in accordance with its general mental and physical condition and psychiatric diagnosis. Although it is generally thought that the procedures for intensive psychiatric care is sometimes too hard or beyond the competence of personnel working in such departments, they are medically necessary and justified.
- Published
- 2013