REMISSION

From Big Medical Encyclopedia

REMISSION (Latin remissio reduction, easing) — the temporary improvement of a condition of the patient which is shown in delay or the termination of progressing of a disease, partial involution or total disappearance a wedge, manifestations of pathological process. The river is a natural phase in nek-ry cases diseases (see), but does not represent return of an organism to a state at all health (see) can be also replaced recurrence (see), i.e. aggravation of pathological process.

R.'s nature in different cases is various. The River can be the cornerstone the wavy character of a course of infectious diseases connected with features of a development cycle of the activator (e.g., at malaria, a typhinia, nek-ry helminthic invasions). At infectious diseases of R. can come also in connection with changes of activity of cellular and humoral immune mechanisms, development of a so-called immunitas non sterilisans, the encapsulation of the infectious centers complicating absorption of toxic products increase in resistance of cellular elements, decrease in sensitivity of a nervous system to toxins, etc. R. can result from changes reactivity of an organism (see) the patient, the climatic and living conditions connected with seasonal factors, favorable changes, character and a diet, and also with the special measures directed to increase specific and nonspecific resistance of an organism (see). Such remissions are observed, e.g., at peptic ulcer (see), Addison's anemias — Birmera (see. Pernicious anemia ), epilepsies (see), to gout (see), etc.

Often R. is caused by the specific therapy which is not leading to radical treatment, but detaining a current patol. process (therapeutic R.). Such R. are observed, e.g., at radiation therapy and treatment by antineoplastic means of malignant tumors, medicamentous therapy of patients with heart diseases, psoriasis, a pemphigus, etc.

Quite often R.'s reasons remain unknown that is usually connected with insufficiency of data on a pathogeny of the corresponding disease; it is accepted to call such R. spontaneous. At nek-ry diseases there can come both therapeutic, and spontaneous R., however, as a rule, R. caused by active treatment arise much more often than spontaneous.

Rubles distinguish on their firmness and depth. Duration (or firmness) R. is measured by duration of the period from the beginning of a condition of R. to recurrence (see) diseases also fluctuates over a wide range — from several days to many years. R.'s depth is defined by extent of delay, a stop or involution of displays of a disease. For a number of diseases there are special gradation and nomenclatures of quality of River.

Remissions at mental diseases represent easing and mitigation patol. symptoms, the providing correct behavior of patients and in a varying degree their social and labor adaptation. They represent the broad range of states from adjoining on practical recovery (full R.) to those, at to-rykh symptoms of defect (incomplete R.) clearly act. At the first option patients truly estimate the postponed disease, find live emotionality and ability to be returned to former work at total absence of symptoms of the postponed disease. It is known that elimination of symptoms of a disease not always demonstrates the termination of process therefore such cases can be qualified as deep remissions. They can spontaneously arise, owing to suspension of process or upon its transition to an inactive state, or as a result of the applied therapy. At the pristupoobrazny and periodic course of a disease, alternating with bad attacks of a disease, R. are caused by features a wedge, pictures of a disease. The probability of emergence of R. is in connection with features of a course of process and the applied therapy.

R.'s firmness is defined by their duration, quality — degree of manifestation of the residual phenomena and extent of social and labor rehabilitation. The R.'s quality is higher, the it appears stronger. The type and character of a current of River matter. As V. Maier-Gross specified, remissions are not with firmness the stabilized states, dynamics is inherent to them.

Wedge, a picture P. develops as of residual symptoms, and symptoms of defect at their different levels, and also existence of compensatory mechanisms and premorbidal features of the personality. However such mnogofaktornost in formation a wedge, pictures does not exclude education separate a wedge, types P. E.g., at schizophrenia V. M. Morozov and To). K. Tarasov (1951) described four types of spontaneous R. — hypersthenic, asthenic, paranoid, hypochiondrial. Later V. M. Morozov described also psychasthenic option of spontaneous remissions. Further G. V. Zenevich (1957) allocated a sthenic, pseudo-psychopathic, paranoid, autistic, apathetic, asthenic, hypochiondrial wedge, therapeutic R.' options at this disease.

Now in connection with broad use psychopharmacological means (see) the pathomorphism of remissions at mental diseases is observed. Asthenic, psychopatholike options, and also R. with subdepressive and hypomaniacal manifestations whereas number P. with the expressed residual procedural signs began to prevail (nonsense, hallucinations, etc.) are observed less often.

Along with the general patterns, inherent R. as to incomplete recovery, at all mental diseases there are, naturally, also specific features for separate nosological forms. E.g., characteristic changes of the personality at remissions of schizophrenia; an urezheniye or the termination of convulsive paroxysms («remission of attacks») and equivalents, and also delay of development of characterologic lines at epilepsy; safety patol. reactivity in relation to ethanol at remissions of an alcoholism, etc. the Remittiruyushchy type of a current with alternation of the periods of considerable improvement is possible at ekzogennoorganichesky psychoses. At traumatic psychoses, in particular, R. can come even after long safety of symptomatology and the weak-mindedness seeming irreversible, manifestations to-rogo, however, smooth out further though its organic nature is represented obvious. The considerable improvement which is followed by this or that degree social and labor rehabilitations (see), it is possible also at residual posttraumatic manifestations in the form of encephalopathy.

The type of remission, structure of defect and character of a course of process in this stage influence the level of social and labor recovery. However the last is to difficult derivatives of a number of factors of both a pathophysiological, and social and psychological order. Not only post-procedural changes and compensatory opportunities, but also last profession, qualification, the seniority, etc. matter. Considerable experience of involvement in work at the industrial enterprises (is accumulated at observance of nek-ry organizational conditions) the patients who are in a condition of remissions at various mental diseases.

The problem of consolidation of R. and prevention of a recurrence has the urgent importance. The important role in this respect belongs to a maintenance therapy. Its essence consists in the prolonged use of the means used for treatment of a disease in the acute period.

The maintenance therapy promotes R.'s firmness and facilitates a possibility of labor rehabilitation. The choice of pharmaceuticals for the specified purpose is defined by the nature of a disease and those means, to-rye were usually applied in the acute period of a disease: psychotropic drugs, including and the prolonged action, at remissions of schizophrenia; anticonvulsant drugs at so-called remission of attacks of epilepsy; salts of lithium for the prevention of affective frustration; Antabusum at remissions of alcoholism, etc. The maintenance therapy should not be limited only to reception of these or those pharmaceuticals, and it is necessary to combine with psychotherapy and rehabilitation actions, implementation to-rykh in these conditions is considerably facilitated. In nek-ry cases of remission of schizophrenia, reached by means of psychotropic drugs, can be interrupted after the termination of reception of maintenance doses.

The problem of prevention of a recurrence requires attention and to a somatic condition of the patients who are in a condition of remission. Exogenous harm, and especially infections, can interrupt River. The aggravation of symptoms and a recurrence of a disease can be provoked by also mental injuries.



Bibliography: Zharikov H. M. Clinical features of remissions at schizophrenia in the remote period of a disease, Zhurn. neuropath, and psikhiat., t. 60, century 4, page 469, 1960; Zenevich G. V. Remissions at schizophrenia, JI., 1964, bibliogr.; Melekhov D. E. Clinical bases of the forecast of working capacity at schizophrenia, M., 1963; Frosts V. M. and Nadsharov R. A. About hysterical symptoms and the phenomena of persistence at schizophrenia, Zhurn. neuropath, and psikhiat., t. 56, century 12, page 937, 1956; Frosts V. M. and Tarasov Yu. K. Some types of spontaneous remissions at schizophrenia, in the same place, t. 20, century 4, page 44, 1951; Sereysky M. Ya. To a question of a technique of the accounting of a therapeutic effectiveness at treatment of mental diseases, Works Ying-that of Gannushkin, century 4, page 9, M., 1939; Mayer-Gross W., Slater E. Roth M. Clinical psychiatry, L., 1960.


H. I. Losev; G. V. Zenevich (psikhiat.).

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