From Big Medical Encyclopedia

MENTALLY SICK (Greek psychikos sincere; synonym: insane, mad, mad, mad) — patients with the acquired or inborn disorder of mental activity.

For P. change of reflection in consciousness of the real world is characteristic that is connected with disturbance of activity of a brain. At the same time there are psychopathological frustration (affective, crazy, in the form of hallucinations, stupefaction, etc.), painful deviations in behavior, the critical relation to the state and surrounding is broken. Character and degree of manifestation of disorder of activity of a brain depend on features of mental diseases (see), their forms and a stage of a current. From P. usually delimit patients with borderline cases — neurosises (see), psychopathies (see) etc. at which disturbance of reflective and cognitive activity of a brain, as a rule, is not observed. However question of P.'s differentiation. and patients with borderline cases is disputable. Quite often the term «mentally sick» designate patients with any mental disturbances.

Deviations in behavior, a lack of motivation of acts, inability to comprehend a situation and to regulate the relationship with the environment, the condition of excitement and aggressive actions would cause the necessity of special care of P., creations of a special type of medical aid — mental health services (see).

P.'s helplessness., absence at some of them consciousnesses of the disease and tendency to socially dangerous actions raise questions of legal character which permission is directed as to protection of the rights and P.'s interests for the state., and on barrier about-va from socially dangerous actions of such patients. In this regard relation to P. and situation them in about-ve depend not only on the level of medical knowledge, but also on a social system, features of a socioeconomic structure.

Separate descriptions of a state and P.'s behavior. are recorded in an extreme antiquity. Singularity of behavior, incomprehensibility of statements and acts long time gave the grounds surrounding to explain their state with intervention of an evil ghost, the investigation of anger of gods, punishment from above. During various eras the relation to P. changed depending on the level of development of medicine and science in general, character of socioeconomic way, the dominating outlook. Scientific approach to P. is characteristic of the Ancient Greek medicine based on materialistic views. Hippocrates considered mental disorders a consequence of diseases, generally a brain. He for the first time described various manifestations of mental diseases (a state with the suppressed or increased mood, with motive and speech excitement, epilepsy with big convulsive attacks and stupefaction), entered a number of terms for their designation, would develop some measures of treatment of P., etc.

In Ancient to Rima A. Tsels made an attempt to create the first systematized treatise on psychiatry. At this time melancholy, manias, epilepsy, acute mental disorders at somatopathies were described. Along with the methods of treatment applied before (emetic and purgatives, walks, a diet, bathtubs. gymnastics, change of climate, etc.) massage, bloodletting, fortifying therapy, elements of psychotherapy was offered, value of physical work was specified.

During blossoming of Muslim culture (8 — 11 centuries AD) the humane relation to P. would be noted.; they were considered having any illness and dug up resources of rendering the help to them. The significant contribution to studying of mental diseases was made by Ibn-Xing who, as well as Hippocrates, would consider the wrong behavior of P. consequence of a disease and, first of all, brain.

The Middle Ages are characterized by regress in understanding of mental diseases. In this regard P. ceased to consider patients, accused them of sorcery, subjected to punishment or destroyed. Special cruelty in relation to P. inquisition differed. Among heretics there would be many P., voluntarily or under tortures confessing to «the intercourses with a devil». At the end of 15 century the special composition under the name «Hammer of Witches» was published, in Krom methods of search and the bringing to inquisition of persons, «given to demons» were in detail described. Burning alive in this connection annually thousands of innocent people (among them there was a lot of mentally sick) perished on fires reckoned with heresy as the main method of controlling.

In Renaissance along with P. abuse. as «demonized» the tendency to their contempt appeared. Item. contained in prisons and monasteries. In Western Europe so-called dollgauz (madhouses) and any shelters in which P. were created. often kept on chains, in iron handcuffs, quite often together with criminals and tramps. Separate attempts of assistance of P. came down, hl. obr., to the distracting methods (patients of a sekla with birches, pricked sharp objects, covered a body with mustard plasters, etc.). Quiet P. remained among the population, lived in families or were on the tramp.

In the ancient time in Russia was considered that frenzied need contempt therefore they along with other gripes (sick, poor, ailing) found a shelter, leaving and care, hl. obr. in monasteries. Features of the Russian culture led to development monastic to lay down. medicine, including and psychiatry (see).

In Russia there would be no P. abuse., as a rule, chains and shackles were not applied, the philanthropic relation to Item 6 prevailed.

Basic change of the relation to P. it is connected with reform of F. Pinel who for the first time created hospital conditions for their treatment. F. Pinel and his pupil Zh. Eskirol laid the foundation of scientific psychiatry. From now on the case history was entered And., new methods of leaving and treatment, including individual work therapy began to be developed. Shelters and shelters turned into clinics. For leaving and supervision of P. attracted specially trained personnel. The first scientific classifications psikhopatol were created. manifestations, and also the scientific guides to psychiatry are issued. There were acts protecting the rights and P.'s interests. At the same time still there would be such measures of constraint of P., as strait jackets, binding of patients with bandage, contents them in insulators.

In the first half of 19 century there would be a change in P.'s treatment.: there was a doctrine about «not constraint», an initiator to-rogo was the English psychiatrist J. Connolly who published the book «Treatment of the Insane without Mechanical Measures of Constraint». Humane relation to P. further progressive psychiatrists of the different countries implemented: in Germany — Meyer (J. E. Meyer) and V. Grizinger (see t. 25, additional materials), in France — V. Manyan, in Russia — S. S. Korsakov.

In the USSR P.'s treatment. it is based on the principles, the general for the Soviet health care (see) in general. It is first of all free of charge and general availability of medical aid, unity of medical and scheduled maintenance. In the USSR since the 20th g along with psychiatric the network of psychoneurological clinics (see the Clinic) which problem — to reveal P. would be developed., to carry out out-patient treatment, to hospitalize P., to render to them medical and a social disease-prevention service after an extract from psychiatric BCs. The great value for improvement and further improvement to lay down. P.'s help. had the Resolution of board of RCP Oil Company RSFSR of October 26, 1931 on check of a condition of psychiatric matter in the republic. It was decided to create system of standard psychiatric treatment and prevention facilities — hospitals (see. Insane hospital), sanatoria, labor colonies and so forth, immediately to start the organization of production workshops at psychiatric-tsakh and psikhonevrol. clinics (see. Medical and production, labor workshops) to strengthen work on P.'s employment.; to improve the help to patients with borderline cases; to pay special attention to strengthening of measures for the organization of the help to children; to develop work on mass psychoprophylactic promotion. All this was a basis for creation of system of mental health services (see).

Broad use of psychopharmacological means (see) in psychiatry changed as the general situation in psychiatric-tsakh and departments, and the nature of care of P., being on hospitalization (see Patient care). Much less often struporous conditions, cases of excitement meet. However at some patients excitement disappears not at once and not completely; such P. need in a gigabyte. leaving and constant observation that they could not put themselves damages. It is the best of all to support them in chambers with a small number of patients. Due to the big prevalence of psychopharmacotherapy in psychiatric the particularly important would become overseeing by a somatic condition of the patients receiving psychotropic drugs behind observance by them to lay down. mode. The weakened patients since they often refuse food in this connection they need forced or artificial alimentation need special leaving also slowed down (a condition of a stupor) and somatic. At a long condition of block they as well as at somatic the weakened patients, can have trophic frustration. Therefore are of particular importance a gigabyte. leaving and fortifying treatment.

In system of the general leaving and overseeing of P. the consistent focus should be provided on the prevention of dangerous actions from their party in relation to personnel and other patients, attempts to suicide. It is also necessary to mean and a possibility of dissimulation (concealment) by patients of the intentions to dangerous actions. It is also necessary to take the measures promoting elimination of vigilance of patients but the relation to psychiatric-tsam: holding group conversations with patients with the purpose to help them is better to adapt to conditions of a hospital, to realize need of the stay in it (see. Psychotherapy ).

Treatment psikhofarmakol. by means it is carried out it is long and systematically even after an extract of the patient from-tsy. Active treatment of patients and care of them out of a hospital shall promote their social and labor adaptation and a readaptation. The beneficial effect on a mental condition of the patient is exerted by work therefore it is necessary to include the patient in work as soon as possible. Character and working conditions of the patient shall be defined taking into account his mental state. Special attention is paid to creation of favorable living conditions. If the patient has difficulties in a family, in relationship with people around, then it is necessary to help it with their elimination; to explain it to relatives of the rule of care of P. At deterioration in a mental condition of the patient overseeing shall be doubled by it, it is necessary to resolve timely an issue of character and conditions of its further treatment.

Bibliography: Dzhagarov M. A. Experience of the organization of a semi-hospital for the insane, the Neuropath, and psikhiat., t. 6, No. 8, page 137, 1937; Dzhagarov M. A. and Balabanova V. K. A day hospital for the insane, M., 1944; Zenevich G. V. Questions of medical examination mentally and nervous patients, L., 1972, bibliogr.; Ibn-Xing of Abu Ali. A canon of medical science, the lane with arabsk., t. 1, book 3, Tashkent, 1958; M. M. Boars, With l at the h e Sunday to and y F. I. and Dedov V. F. Day hospitals as institutions of «partial hospitalization» in system of mental health services, Zhurn. neuropath, and psikhiat., t. 65, No. 8, page 1266,1965, bibliogr.; Kannabikh Yu. V. History of psychiatry, L., 1929; Seventh All-Union congress of neuropathologists and psychiatrists, t. 1, M., 1981.

M. V. Korkina; N. M. Zharikov (treatment and care of mentally sick).