содержание .. 1 2 3 4 ..
Посттравматическое стрессовое расстройство (взрослые). Клинические рекомендации (2023 год) - часть 3
когда он комбинируется с использованием методов когнитивно-поведенческой терапии.
Способность #гидрокортизона** оказывать влияние на боевые стрессовые расстройства
требует изучения. Однако уже отмечается, например, что короткий, 10-дневный, курс
терапии небольшими дозами - по 40 мг #гидрокортизона** в сутки перорально - позволяет в
течение ближайших трех месяцев уменьшить число и выраженность симптомов ПТСР у
лиц, перенесших тяжелые травмы. Таким образом,
#гидрокортизон** предотвращает
развитие симптомов стрессовых расстройств в меньших дозах, чем те, которые
оказывают влияние на заживление ран или риск инфицирования.
81
7. Дополнительная информация (в том числе факторы, влияющие на исход
заболевания или состояния)
Факторы, способствующие затяжному течению
(предикторы затяжного течения ПТСР)
[16,284,285,286,287]:
Клинико-
данные за наличие тревожных и/или аффективных
биологические
расстройств в анамнезе;
предикторы
наличие сочетанных экзогенно-органических
затяжного течения
(травматические) поражений головного мозга;
ПТСР
коморбидные психические расстройства;
коморбидные соматические расстройства;
злоупотребление психоактивными веществами;
пролонгированная актуальная стрессовая ситуация в
сочетании с низкой фрустрационной толерантностью;
терапевтическая резистентность;
Психологические
высокий уровень невротичности;
предикторы
преобладание зависимых черт личности;
затяжного течения
трудности в построении стабильных межличностных
ПТСР
отношений;
Социальные
отсутствие социальной поддержки в период после
предикторы
травматического события;
затяжного течения
предшествующая хроническая психическая
ПТСР
травматизация;
недостаток навыков проблемно-решающего поведения;
наличие выраженного травматического опыта в детском
возрасте.
82
Критерии оценки качества медицинской помощи
Критерии качества
Уровень
Уровень
достоверности
убедительност
доказательств
и
рекомендаций
Этап постановки диагноза
Выполнено клиническое обследование
А
1
(собраны клинико-анамнестические, клинико-
психопатологические данные), установлено
соответствии диагностическим критериям
ПТСР по МКБ-10
Выполнено
экспериментально-
А
1
психологическое обследование
Проведены общий
(клинический) анализ
В
2
крови,
анализ
крови биохимический
общетерапевтический, анализ мочи общий,
исследование уровня общего трийодтиронина
(Т3) сыворотки крови, уровня свободного
трийодтиронина сыворотки
(Т3), уровня
общего тироксина
(Т4) сыворотки крови,
уровня свободного тироксина сыворотки (Т4)
крови, уровня тиреотропного гормона в крови
Оценено наличие коморбидной психической
В
2
патологии
Оценено наличие коморбидной соматической
В
2
патологии
Выполнена электрокардиография
А
1
Оценен риск суицидального поведения
А
1
Оценено наличие социальной поддержки
В
2
Этап лечен00ия
Проведено
назначение
СИОЗС или
А
1
венлафаксина
Проведен
анализ
эффективности
и
А
1
переносимости назначенной терапии (на 7-14-
28 день и далее ежемесячно)
Проведена смена терапии при отсутствии
А
1
эффективности или непереносимости терапии
Проведена психотерапия
А
1
83
Достигнуто
уменьшение
уровня
А
1
выраженности симптоматики
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