Российская академия наук

Features of diagnosis and treatment of concussion resulting from domestic violence

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Features of diagnosis and treatment of concussion resulting from domestic violence

Gorbatkova E.A., Hoshafyan D.V., Gordeeva A.V.

GKUZ "mental hospital" Rostov region, Rostov - on - Don, Russia, gorbatkowa@yandex.ru

MBUZ "GBSMP" Rostov - on - Don, Russia, khoshafian.dina.64.@Mail.ru, gordeewa.aw@mail.ru
It is known that traumatic brain injury (TBI) has a prominent place in the injury and is 40-50% of all injuries. Concussion (SUM) - the most common type of traumatic brain injury (70-80% of all TBI). Clinical neurological study in combination with modern neuroimaging techniques (computed tomography, magnetic resonance imaging) allows a high level of reliability to diagnose concussion. However, the structure of patients with SHM, obtained in a situation of domestic violence, there are essential differences that affect the course and prognosis of the disease. These features include multiple persistent complaints of poor physical health, emotional expressed disorders (irritability, resentment, tearfulness, conflicts), slightly korriliruyuschie with rapid regression of neurological symptoms on a background of biological treatment.

The purpose of this study was a comprehensive study of the status of this category of patients with their psychological trauma and personality, influencing the course of the underlying disease (TBI SGM) and the effectiveness of treatment.

The studied group consisted of 9 people (women) who received a concussion as a result of being beaten by their families or members of the immediate environment. All patients were young working age from 20 to 39 years. The majority - with secondary education (6 persons), three - with higher education. Eight of nine before entering the neurosurgery department did not have any physical or neurological diseases.

We used the following methods of diagnosis: a neurological examination (inspection, assessment of the level of consciousness, neurological status - function of the cranial nerves, motor and sensitive areas of coordination, the presence of symptoms of irritation of the meninges, skull radiographs, the cervical spine, computed tomography of the brain , visit an ophthalmologist) and experimental psychological research (the method of election of color and an abridged version of the Minnesota multidimensional personality inventory MMPI).

According to a standardized neurological studies, all patients in this group was observed brief loss of consciousness, memory impairment (retro-, con-anterograde amnesia for a short period of time), cerebral syndrome psychovegetative syndrome (emotional instability, fluctuations in blood pressure, heart rate lability, nausea, vomiting , pallor, sweating), vestibular disorders (dizziness, nystagmus), ataxia. According to imaging, the X-ray of skull and cervical spine revealed no bone-traumatic changes, computed tomography showed no abnormalities in the traumatic state of matter of the brain and intracranial spaces likvorosoderzhaschih, research fundus abnormalities are not detected.

According to experimental psychological research, the emotional state of patients experience marked by intense anxiety (7 women), the spectrum of depressive experiences (5 women), suspicious cautious attitude to others (2 women), fear domestic aggressor (9 women), a pessimistic attitude towards the future, self-doubt,

feelings of helplessness and exhaustion. The study helped identify some common to all women personal characteristics affecting the prognosis of health and adaptation. So, in 8 women have an addiction to a state of confusion, mental confusion, passive-defensive, in stressful situations. The structure of psychological defenses 8 women, the leading light of the scope of the mechanism of repression of consciousness unpleasant information that prevented them to recognize early signs of the threat of domestic violence and take appropriate measures to ensure their own safety. Psychological characteristics of patients referred to determine the need to provide them not only medical care but also psycho specialized assistance to abreaction of traumatic experiences, reconstruction mechanisms of coping skills development to ensure their own safety. Psychological adjustment was also aimed at preventing the development of personality hypochondriacal patients due to the fact that in their personality structure revealed a tendency to hypochondriacal fixation on bodily symptoms.

Thus, in view of the mixed structure of the patient, the treatment strategy was developed, including drug therapy (analgesics, anti-emetics, tranquilizers, nootropic, vasoactive drugs) and psychological correction using the methods of crisis intervention.

As a result of comprehensive treatment for all patients of the study group was observed not only the objective regression of neurological symptoms, but marked improvement emotional and adaptive capacity.

Summing up the experience of complex examination and treatment of patients with brain concussion, obtained as a result of domestic violence, it should be recommended by differential diagnosis of emotional disorders associated with the actual SGM and psychological trauma, and as a result, to plan activities to treatment not only SHM but psychological trauma, and the prevention of hypochondriacal personality victims.

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