Curs Studenti Psihofarma ANXIETATE 2016

8/16/2019 Curs Studenti Psihofarma ANXIETATE 2016

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Conf. Dr. DANIEL VASILE

Medic primar psihiatruDoctor în ştiinţe medicale

ef Clinic! "sihiatrieSC#MC $Dr. Carol Da%ila& 'ucureşti

"SI()"A*)L)+IA ,I-AMAC)L)+IA

*#L'#/IL) AN0I)ASE


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CLASA DE A+EN1I -AMAC)L)+ICI E0EM"LE DE A+EN1I

-AMAC)L)+ICI'EN2)DIA2E"INE(MODULATORI ALOSTERICI POZITIVI AIRECEPTORILOR GABA-A)

LORAZEPAM, CLONAZEPAM,ALPRAZOLAM

LI+AN2II S#'#NI*/1IL) AL-A343

DEL*A ALE CANALELOR DE CALCIUVOLTAJ-SENZITIVE PRESINAPTICE N ȘIP/Q

PREGABALIN, GABAPENTIN

A+)NI,*I "A1IALI AIECE"*)IL) 5(*6A

BUSPIRONA

IN(I'I*)II SELEC*IVI AIECA"*/II SE)*)NINEI FLUOXETINA, SERTRALINA,ESCITALOPRAM

IN(I'I*)II ECA"*/IISE)*)NINEI ,I N)ADENALINEI

VENLAFAXINA

IN(I'I*)II ECA"*/IISE)*)NINEI ,I A+)NI,*I

"A1IALI 5(*6A

VILAZODONA

TERAPIA ANXIETĂȚII


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CLASA DE A+EN1I-AMAC)L)+ICI

E0EM"LE DE A+EN1I-AMAC)L)+ICI

IN(I'I*)IIM)N)AMIN)0IDA2EI

FENELZINA

AL-A6 AN*A+)NI,*I PRAZOSIN

'E*A3'L)CAN*E PROPRANOLOL

AL-A4 AN*A+)NI,*I MIRTAZAPINAAN*A+)NI,*I 5(*4 ,IIN(I'I*)I AI ECA"*/IISE)*)NINEI

TRAZODONA

AN*IDE"ESIVE *ICICLICE AMITRIPTILINA, CLOMIPRAMINA,IMIPRAMINA

AL*ELE ETIFOXINA (AGONIST ALSUBUNITĂȚILOR ! ȘI " GABA-A)#IDROXIZINA (ANTAGONIST #$,M$ ȘI %#T!)

TERAPIA ANXIETĂȚII


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*#L'#AEA DE

AN0IE*A*E DESE"AAE


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F&' *+ +.'0+0 .*'1 *+ '+21+0 *0+2'3'2 241530+& +3 *6'03' 7&'1'2 *7+&+&+ 27&*5+3 2 +& +*0+ * *'80 +0+9+0, 27 8&430 2' 7&4:+ + 3 7:' " 2' &805+&3;

-2'*0&* .*'1 &&0 +0' &'?5&+& 7&*'*00 9' .*'1 3>+0 2

7'&2&+ =>&'35& 2 +0+9+80 8+?5& *+ 75*'6'33108&' +& +& 70+ *&1' 3+ +2&*+ +*05&+ 2'&8, 2 . 653', 0&+8+0'*8, 24+*0&, 2*@

TULBURĂRILE ANXIOASE


6/61

->&'?5&+& 7&*'*00 9' .*'1 +: 2 0&'&+' 1'80 +9070+0 (2 . + * 7'&2, + =&7'0, + +1+ +'20, + * 86531') +& +&52 3+ *7+&+&+ 2 =>&'3 2 +0+9+80@- &4&1 7&*'*00 *+ &4 2 + '9' 2' +*2' +4+ &''' 2 *7+&+&@-&' 7&*'*00 9' .*'1 *+ &4&1 +&8


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-598+&&' &70+0 +& '873' 08+ *7&&''@-+4 &70+0 2 *'87058 =4' (2 . +3, 2&&'+6258'+3, *4+:' 2 >&+: *+ 1&*0&') +0' &'3 2 +0+9+80 8+?5& *+ +0'


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M#*ISM#L SELEC*IV


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E9 &70+0 2 + 15&6' *'0+:'' *5'+3 *7'= +&*0 2 +9070+0 + 7&*5++ * 15&6+* (2 . 3+ 95+3),29' 15&690 +30 *'0+:'' (2 . ++*)

T36&+&+ '0&& 7&5&8+:3 2+:'5+3 *+57+:'5+3 *+ 58'+&+ *5'+3

D&+0+ 036&&'' *0 2 8''8 5 3 (9' *0 3'8'0+0 3+7&'8+ 3 2 95+3)

E93 2 + 15&6' 75+0 = +0&'6'0 3'7*' 2 5+90& +/3'7*' 2 +8'3'+&'0+0 3'86+?3 15&6'0 *+& *'0+:''35&*5'+3

T36&+&+ *0 8+' 6' .73'+0 2 5 036&+& 258'+& 9' +7+& .3*'1 0'873 153:''036&&'35& 2 *70& +0'*0, *'45&'', +30' 036&&'7*'50'



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-)'IA S"ECI-IC/


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A.'0+0 8+&+0 *+ &' .*'1 2 56'0 *+ *'0+:' *7'= (2 . 465& +1'53, 3:'8', +'8+3, + + 5 '?:', +

12+ *)S'0+:'+ *+ 56'03 56' +7&5+7 0502++

7&515+ &'/+.'0+0 '82'+0S'0+:'+ *+ 56'03 56' *0 1'0+0 +0'1 *+

*75&0+0 &' '0* *+ +.'0+0F&'+ *+ +.'0+0+ *0 2'*7&575&:'5+0 +:

2 7&'533 &+3 '873'+0 2 56'03/*'0+:'+*7'= 9' +: 2 50.03 *5'530&+3



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F&'+/+.'0+0+/1'0+&+ *0 7&*'*00, 2&')/*'0+:''/+303



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-)'IA S)CIAL/

7*#L'#AEA DE AN0IE*A*ES)CIAL/8


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F&'+ 8+&+0 *+ +.'0+0+ 3>+0 2 + *+ 8+'830 *'0+:'' *5'+3 +& 7&*5++ *0 75*'6'3 *= 56*&1+0 2 0& ' 2' ?& D . '0&+:''*5'+3 (+ +1+ 5 51&*+:', + * 0


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S'0+:''3 *5'+3 *0 1'0+0 *+ 2&+0 &' *+ +.'0+0 '0*

F&'+ *+ +.'0+0+ *0 2'*7&575&:'5+0 +:

2 +8':+&+ &+3 '873'+0 2 *'0+:'+*5'+3 9' 2 50.03 *5'5-30&+3F&'+, +.'0+0+ 9'/*+ 1'0+&+ *0

7&*'*00, 0'7' 2&+4 8''8 3'

F&'+, +.'0+0+ 9'/*+ 1'0+&+ +4+42'*0&* 3'' *8'=+0'1 *+ 2'*:'*5'+3, 57+:'5+3 *+ +30 +&'''875&0+0 2 :'5+&



16/61

F&'+, +.'0+0+ 9'/*+ 1'0+&+ 750 = *0&'6'0035& =4'535>' +3 ' *6*0+:, CMG 5&' +30'036&&' 7*'' (036&+& 2 7+', 036&+&2'*85&= 5&75&+3, 036&&' 2 *70& +0'*0)

D+ .'*0 5 585&6'2'0+0 5&>+' ( 2 . 65+3P+&'*5, 564'0+0, '+0&'' 75*0-586*0'5+30), +0' &'+, +.'0+0+ *+ 1'0+&+ *0 3+&3>+0 2 ++*0+ *+ *0 .*'1

S7'=+:'; *60'73 2 7&5&8+: (.3*'1)- &'+*0 3>+0 2 15&6'03 763' *+ 2 +7+&':''3 763'



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*#L'#AEA DE

"ANIC/


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A0+&' 2 7+' recurente spontane U +0+ 27+' *0 5 +7+&':' 6&* + ' *0&' 2 &''0* *+ 2 2'*55&0 '0* +& +0'> 8+.'8


19/61

->&+: *+ 2'*55&0 +6258'+3-*4+:' 2 +8:+3, 24'3'6&, 1&0'? *+39'

-&'*5+ *+ 1+3&' 2 32&-7+&*04'' (*4+:'' 2 +85&:3' *+&'0&')

-2&+3'4+& (*0'80 2 '&+3'0+0) *+27&*5+3'4+& (20+9+& 2 *' *9')-0+8+ 2 6' *+ 2 7'&250&533

-0+8+ 2 85+&0



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C3 7:' +0+ 2 7+' + 5*0 *5:'0 2 8''8 53 2 3 *+ +863;

->&'?5&+& *+ 7&57+& 7&*'*00 3>+0 275*'6'3'0+0+ +305& +0+&' 2 7+' *+ 2 5*'H3+*05&+ (7'&2&+ 50&533', + +1+ +0+ 2 5&2, +

6')-5 852'=+& *8'=+0'1 + 5875&0+803' + &8+&+ +0+&'35& 2 7+' (2 . 5875&0+80 2 1'0+& +.&'H''35& =4' *+ + *'0+:''35& +8'3'+&)

T36&+&+ 75+0 = +0&'6'0 035& =4'535>' +3 '

*6*0+: *+ CMG 9' 8+'*0&'3 *0 8+' 6'.73'+0 7&' +30 036&+& 7*'' (56' *5'+3, 56'*7'=, TOC, TSPT, 036&+& 2 +.'0+0 2 *7+&+&)



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A+)A-)'IA


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F&'+ 8+&+0 *+ +.'0+0 3>+0 2 25 *+ 8+' 830 2'&805+&3 *'0+:'';

$ F535*'&+ 8'?35+35& 2 0&+*75&0 58! A * ++ *7+:'' 2*'*

" A * >*' *7+:'' '* A *0+ 3+ &&

P&*5++ * 08 *+ 1'0 +*0 *'0+:'' 2' +4+ >


23/61

S'0+:''3 +>5&+56' *0 1'0+0 +0'1, *'07&4:+ ' *5:'05& *+ *0 2&+0 &'/+.'0+0 '0*F&'+ *+ +.'0+0+ *0 2'*7&575&:'5+0 +: 2

7&'533 &+3 '873'+0 2 *'0+:''3 +>5&+56' 9' 250.03 *5'5-30&+3F&'+, +.'0+0+ 9' 1'0+&+ *0 7&*'*00, 2&


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D+ 5 +30 7+0535>' 5&>+' *0 585&6'2(2 . 65+3+ '+8+05&' + 5353', 65+3+P+&'*5), +0' &'+, +.'0+0+ *+1'0+&+ *0 3+& .*S'870583 *0 8+' 6' .73'+0 2 5+30 036&+& 80+3 (56' *7'=, 2 .,

TOC, 036&+&+ 2'*85&= 5&75&+3, TSPT,036&+&+ +.'0:'' 2 *7+&+&)M:'; A>5&+56'+ * 2'+>5*0'+4'2720 2 036&+&+ 2 7+', 2+&75+0 = 585&6'2 ++*0+



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*#L'#AEA DEAN0IE*A*E

+ENEALI2A*/


26/61

A.'0+0 .*'1 *+ >&'?5&+& (.70+:'' +7&*'1), +& +7+&8+' 830 4'3 2+ 20& 8&2 +0'1'0:' (2 . 7&5&8+:3 953+& *+ 7&5*'5+3)

P&*5++ 5*'2& *0 2'='3 *-9' 50&534 >&'?5&+&+A.'0+0+ 9' >&'?5&+&+ *0 3>+0 2 " (*+ 8+' 830) 2'

&805+&3 *'87058 (2' +& 3 7:' & *+ 8:' 2'=30+0*583, 5&' 3''90, *58 *+0'*05&)



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A.'0+0+, >&'?5&&'3 *+ *'870583 =4''2 2'*0&* 3'' *8'=+0'1 *+ 2'*:''*5'+3, 57+:'5+3, 5&' +30 +&'' '875&0+0

T36&&'3 750 = +0&'6'0 035&=4'535>' +3 ' *6*0+:, +305& CMG 5&'+305& 5&8 2 7+0535>' 7*'' (56'+ *5'+3,

TOC, 036&+&+ 2 +.'0+0 2 *7+&+&, TSPT, +5&.'+ &15*+, 036&+&+ *'87058 *58+0', 036&+&+ 2'*85&=5&75&+3, 036&+&+ +.'0+0 3>+0 265+3, *'45&' *+ 036&+&+ 23'&+0)



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N)1I#NI DEMANA+EMEN**EA"E#*IC


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*#L'#AEA DE "ANIC/3ISS9 :en;odia;epine< prim! linie de

tratament3AD triciclice9 tetraciclice9 IMA)

3%enlafa=ina9 com:ina>ii de antidepresi%e culitiu?:uspiron!

3durata terapiei@ 364 luni din momentulo:>inerii unui r!spuns terapeutic

3B3 din pacien>i recad dac! oprescmedica>ia9 chiar dac! au o:>inut un r!spunsterapeutic :un

3terapii coFniti%e Gi comportamentale



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*#L'#AEA DE AN0IE*A*E +ENEALI2A*/3psihoterapie coFniti%3

comportamental!9 suporti%!9 :a;at!pe insiFhtH

3ISS93:uspiron!93%enlafa=in!9

3:en;odia;epine.



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A+)A-)'IA-6452'+47', ISRS, AD 0&''3' *+ 00&+'3'-7*'50&+7' *75&0'1@ 7*'++3'4@ 0&+7'5875&0+80+3@ 5>'0'1@ 0&+7' 1'&0+3

-)'IILE S"ECI-ICE-0&+7'+ 5875&0+80+3, 7*'++3'4+, 0&+7'+ 1'&0+3-+30 5&8 2 0&+7'; '754+, 0&+7'+ *75&0'1, 0&+7'++8'3'+3

-)'IA S)CIAL/

-ISRS, 652'+47', 13++.'+, 6*7'&5+- +4&' *1&, &&+0+&; IMAO- +.'0+0+ 2 7&5&8+:; 60+-635+0

-7*'50&+7' 5>'0'1-5875&0+80+3



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*#L'#/ILE DINS"EC*#L )'SESIV3

C)M"#LSIV


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"re;en>a o:sesiilor9 compulsiilor sau a am:elor@-56**''3 *0 2='0 7&' ($) 9' (!);($) >'' &&0 9'7&*'*00 +& *0 0&'0, 3+ 8580 2+0 77+&&*3 036&&'' + '0&4'1 *+ 25&'0, '+& 3+ '8+' 83:' 7+':' 20&8' +.'0+0 8+&+0 *+2'*55&0 *8'=+0'1@(!) '2'1'23 +& * '>5& *+ * *7&'8 +*03

2 >'', 5&' +& * 30&+3'44 >


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-5873*''3 *0 2='0 7&' ($) 9' (!);($) 5875&0+80 &70'0'1 (2 . *73+&+ 8+0 * 3 04 + &*7* 3+ 556**' *+ 55&8 5& &>3' +& 0&6' +73'+0&'>'2@(!) 5875&0+80 *+ +0 80+3 +& *0 2*0'+07&1'&'' *+ &2&'' +.'0:'' *+ 2'*55&03', 5&'

7&1'&'' ' 1'80 *+ *'0+:'' 080@ * +*05875&0+80 *+ +0 80+3 *0 50+0 852 &+3'*0 + *0 2*0'+0 * 0&+3'44 *+* 7&1', 5&' *0 3+& 2'*7&575&:'5+0



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O6**''3 9' 5873*''3 *0 5*8+05+& 2 0'87(2 . *'0 7*0 5 5& 7 4') *+ +4+42'*55&0 3'' *8'=+0'1 *+ 2'*:'' *5'+3,57+:'5+3 *+ +30 +&'' '875&0+0

S'870583 750 = +0&'6'0 035& =4'535>'+3 ' *6*0+:, +30' CMG, 5&' +30' 036&&'80+3 (2 . 036&+&+ 2 +.'0+0 >&+3'4+0,036&+&+ 2'*85&= 5&75&+3, 53:'5+&'*837+0535>', 0&'50'358+'+, .5&'+:'+ 7+0535>',

036&+&+ 2 +.'0+0 3>+0 2 65+3, 036&&'3+2'0'1, 7+&+=3''3, 27&*'+ 8+?5&, 036&&'3 2'*70&3 *'45&'', 036&&'3 2' *70&3 +0'*0)

TULBURAREA OBSESIV-COMPULSIVĂ


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S7'=+:';3cu insiFht :un sau accepta:il 7+'03&5+90 *'870583 56**'1-5873*'1 *0 852 *'>& *+ 7&56+6'3 &+3'*0 *+ 5*'2&

+*0 *'87058 +& 70+ * = *+ * = &+3'*0@3cu insiFht redus 7&*5++ 5*'2& *'870583 56**'1 9' 5873*'1 *0 .*'1 *+?*0'=+03cu idei delirante? insiFht a:sent '2'1'23 *058730 51'* '2'3 23'&+0 &0 &+3'0+0+3cu ticuri; 7&*5++ +& 5 036&+& 2 0'7 0' +020 *+ 7&40

TULBURAREA OBSESIV-COMPULSIVĂ


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P&57+& 3 *+ 8+' 830 20 7&70*+ '87&:'' +3 +*703' =4' +& *056*&1+6'3 *+ *0 5*'2&+0 8'5& 2 '3+3:'

L+ +8'0 8580 7 7+&&*3 153:''

036&&'', 7&*5++ + +10 5875&0+80&70'0'1 (1&'=+&+ +*703' 5>3'2, >&'?'&.*'1, +0 +*'>&&') *+ +0 80+3(587+&+&+ +*703' =4' 7&57&' 3 +3 +305&+)+ &*7* 3+ 7&57&' 7&'1'2 7&57&'+ :'9+&

P&57&'3 20&8' 2'*0&* *+ 2'*:'*5'+3, 57+:'5+3 *+ +30 +&'' 2 :'5+&

TULBURAREA DISMORFICĂCORPORALĂ

Ă


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P&57&'3 3>+0 2 +*703 7&57&' *0 8+' 6'.73'+0 2 >&'?' 3>+0 2 :*03 +2'75* *+ 2 >&0+0+5&75&+3 3+ 7+':' +& + &'0&'' 2 036&+& 25875&0+80 +3'80+&S7'=+:';

3cu dismore muscular!; 7&*5++ *0 7&57+0 2'2+ 7&57&'3 5&7 *0 7&+ &+>'3 *+ '*='0 28*35*3Fradul de insiFht; &2* (&2 '2'3 3>+0 2+*703 5&75&+3 *0 7&56+6'3 +21&+0)/ 6 *++70+6'3 (&5+90 '2'3 *+3 *0 3+& +21&+0/7&56+6'3 +21&+0/ +& 70+ = *+ +21&+0)/ '*'>0 +6*0 5&' '2' 23'&+0 (*0 58730 51'* '2'3 *+3 *0 +21&+0)

TULBURAREA DISMORFICĂCORPORALĂ


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D'=30:' 7&*'*00 + &:+ 3+ +8'0 56'0,'2'&0 2 1+35+&+ 35& &+3

A+*0 2'=30+0 *0 5*':+ 15'' 7&70 27+'0 2 + 7*0&+ 56'03 9' + 2'*55&03' +*5'+0 +6+25+&+ 35&

D'=30+0+ 2 + &:+ 3+ 56'03 7&57&'' +& + &8+&+83+&+ 35&, +>358&+&+ *8'=+0'1 + *7+:'3' +& 7&*5++ 35'90, 587&58':


40/61

C53:'5+&'*83 75+0 = +0&'6'0 +30'CMG (2 . TCC, AVC, *'2&58 P&+2&-K'33')

C53:'5+&'*83 75+0 = 8+' 6'.73'+0 2 5 +30 036&+& 80+3 (TOC,036&+& 27&*'1 8+?5&, *'45&' *+

+30 036&&' 7*'50', 036&+&&55>'0'1 8+?5&, 036&&' 2 *70&+0'*0)

S7'=+:';3cu acumulare e=cesi%!; 2+ 2'=30+0+

2 + &:+ 3+ 56'0 * +*5'+4 +'4':'5+&+ .* + '08'35& +& *0 *+&' *+ 70& +& *0*='0 *7+:'

3cu insiFht :un sau accepta:il? cu insiFhtsc!;ut? f!r! insiFht sau cu ideidelirante

COLECȚIONARISMUL PATOLOGIC

S'2&583 P&+2&-

K'33'


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S83>&+ &&0 + 7&57&'3' 7&, + 52 3+ 7'&2&+ 50+6'3 + 7&3'

&&' &70+0 2 + &2 *+ 2 +*057+ *83>&+ =&35& 2 7&

S83>&+ =&35& 2 7& 20&8'2'*55&0 *+ 2'*:'' *5'+3,57+:'5+3 *+ +30 '875&0+0 2+0'1'0+0

A*0 5875&0+80 *0 8+' 6'.73'+0 2 5 +30 CMG (2 . 5 65+32&8+0535>') *+ 2 5 +30 036&+&7*'' (036&+& 2'*85&= 5&75&+3, 2.)

TRICOTILOMANIA


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C5875&0+80 &70+0 2 '7'& + 7'3'',+& 20&8' 34'' 0++0

&&' &70+0 2 + &2 *+ *057+5875&0+803 8:'5+0

C'7'03 7'3'' '2 2'*0&* *8'=+0'1*+ 2'*:'' *5'+3, 57+:'5+3 5&' +30 +&'' 2 +0'1'0+0

C5875&0+803 *0 8+' 6'.73'+0 2 03 =4'535>' +3 '*6*0+: (2 . 5+'), 2 5 CMG (2. *+6'), 5&' 2 5 036&+& 7*''(036&&' 7*'50', 036&+&+ 2'*85&=5&75&+3, 036&+&+ 8'9&'*0&50'7, +05108&' & '0:'*''2+& 0)

TULBURAREA DE EXCORIAȚIE


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N)1I#NI DE

MANA+EMEN**EA"E#*IC

TULBURĂRILE DIN SPECTRUL

OBSESIV-COMPULSIV

TULBURĂRILE DIN SPECTRUL


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*EA"IA *#L'#/II )'SESIV3C)M"#LSIVE3ISS9 clomipramin!3de re;er%!@ ad!uFarea de %alproat? litiu? car:ama;epin!Hse poate încerca %enlafa=ina9 pindolol9 IMA)9 :uspiron!9

53(*9 l3triptofan9 clona;epam9 risperidon!

3terapie comportamental!3psihanali;!9 terapie suporti%!9 terapie familial!93*EC Gi psihochirurFie în ca;urile se%ere9 refractare3Stimularea cere:ral! profund! cu electro;i în nucleii:a;ali

*#L'#AEA DISM)-IC/ C)")AL/3AD triciclice9 IMA)9 pimo;id9 ISS9 clomipramin!3ISSJclomipramin!9

ISSJ:uspiron!?litiu?metilfenidat?antipsihotice

TULBURĂRILE DIN SPECTRULOBSESIV-COMPULSIV


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*#L'#/ILE LE+A*EDE AC1I#NEA #N)

*A#ME SA#S*ES)I

TULBURAREA DE STRES


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A. E=punerea la amenin>area cu moartea sau lae%enimente soldate cu decesul unor persoane9traumatisme se%ere9 %iolen>! se=ual!9 dup! cumre;ult! din cel pu>in unul din criteriile urm!toare@ *r!irea direct! a unui e%eniment traumatic A martor9 în persoan!9 la un e%eniment traumatic la

care au participat alte persoane Aarea %eGtii c! un e%eniment traumatic a sur%enit

unei persoane apropiate9 mem:ru al familiei sauprieten. Dac! e%enimentul a implicat decesul sauamenin>area cu moartea în ca;ul unei persoaneapropiate9 atunci e%enimentul a fost %iolent sauaccidental.

A tr!i e=punerea repetat! sau e=trem! la detaliia%ersi%e ale e%enimentului traumatic 7de e=. în ca;ulpoli>iGtilor9 pompierilor9 leFiGtilor etc8. De men>ionatc! acest criteriu nu se aplic! în situa>iile de e=punereprin mass3media9 computer9 lme9 cu e=cep>ia ca;ului

în care e=punerea este leFat! de acti%itateaprofesional!.

TULBURAREA DE STRESPOSTTRAUMATIC LA ADULT

TULBURAREA DE STRES


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'. "re;en>a unuia sau mai multor simptome de tipintru;i% asociate cu e%enimentul traumatic9 de:utat7e8dup! e%enimentul traumatic@ A8'0'&' +3 1'803' 0&+8+0' &&0, '1530+&,

'0&4'1, +*5'+0 2'*55&0 V'* &&0, 730, 08+0' 3>+0 2 1'8030&+8+0'

R+:'' 2'*5'+0'1 (2 . +*6+-&'), 0'873 &5&+7&*5++ *'80 *+ +:'5+4 + 9' 8 *-+& 7&52 2' 51'803 0&+8+0'

D'*55&0 '0* *+ 7&3>'0 3+ .7&+ 3+ *0'83' '0&' *+.0&' +& *+8 +*70 +3 1'803' 0&+8+0'

R+:'' 8+&+0 =4'535>' 3+ *0'83' '0&' *+ .0&' +&*'8653'4+4 *+ *+8 +*70 +3 1'803'0&+8+0'


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C. E%itarea persistent! a stimulilor asocia>i cue%enimentul traumatic9 e%itare care începedup! respecti%ul e%eniment9 dup! cum re;ult!din pre;en>a unuia sau a am:elor criterii de mai

os@-1'0+&+ *+ .'*0:+ 5& 5&0&' 8+&' 2 + 1'0++8'0'&', >+0 2 / *0&


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D. Modic!ri neFati%e ale coFni>iilor Gi dispo;i>ieiasociate cu e%enimentul traumatic9 care încep sau seaFra%ea;! dup! ce a ap!rut un e%eniment traumatic9dup! cum re;ult! din dou! sau mai multe din

urm!toarele semne@-'+7+'0+0+ 2 +-9' &+8'0' +*70 '875&0+0 +31'803' 0&+8+0' (0'7' 2+05&+0 ' +84'' 2'*5'+0'19' +305& +05&' 8 +& = TCC, +35533' *+ 2&5>&'35&)-&2': *+ .70+:'' >+0'1 .+>&+0 9' 7&*'*00

3>+0 2 *', +3:'' *+ 38 (2 . N 750' +1+ '&2& ''8', L8+ *0 5+&0 7&'35+*+, T50 *'*083 8&15* *0 '&82'+6'3 &'+0)-5>':'' 7&*'*00, 2'*05&*'5+0 3>+0 2 +43 *+5*':3 1'803' 0&+8+0', +& 52 '2'1'23 3++0563+8+& *+ 3+ 1'51:'&+ 35&3+3:'


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-*0&' 85:'5+3 >+0'1 7&*'*00 (2 ., &', 5&5+&, &', 1',&9')

-'0&* 8+&+0 2'8'+0 70&/ &2&+ 7+&0''7&'' +0'1'0:''875&0+0@

-*4+:'+ 2 20+9+& *+ *0&'+& 2 '3+3:'@

-'+7+'0+0 7&*'*00 2 + 0&' 85:'' 754'0'1

E. Alterarea marcat! a e=cita:ilit!>ii Gi reacti%it!>ii asociate cue%enimentul traumatic9 începnd sau aFra%ndu3se dup!apari>ia e%enimentului traumatic9 dup! cum re;ult! din celpu>in dou! semne din urm!toarea list!@

-5875&0+80 '&'0+6'3 *+ &'4 2 &', .7&'8+0 0'7' 7&'+>&*'1'0+0 1&6+3 *+ =4' +: 2 5+8' 9' 56'0@

-5875&0+80 '&*75*+6'3 *+ +052'*0&0'1@

-'7&1'>'3:@

-&*7* 2 0&*&'& .+>&+0@- &5638 2 50&+&


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D&+0+ 7&0&6&'35& (&'0&''3 2 3+ A 3+ E) *0 7*0 53

M+'*0&'3 3'' +4+4 2'*0&* *8'=+0'1 *+2'*:'' *5'+3, 57+:'5+3 *+ +30 +&'' '875&0+0

T36&+&+ *0 8+' 6' .73'+0 2 03 '*6*0+: *+ 2 5 +30 CMG

S7'=+:';- *'87058 2'*5'+0'1; 27&*5+3'4+& 9'/*+

2&+3'4+&- 260 05*0' 2 TSPT *0 273''0 2


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A. E=punerea la amenin>area cu moartea sau la

e%enimente soldate cu decesul unor persoane9traumatisme se%ere9 %iolen>! se=ual!9 dup! cum re;ult!din cel pu>in unul din criteriile urm!toare@ *r!irea direct! a unui e%eniment traumatic A martor9 în persoan!9 la un e%eniment traumatic la care

au participat alte persoane Aarea %eGtii c! un e%eniment traumatic a sur%enit uneipersoane apropiate9 mem:ru al familiei sau prieten. Dac!e%enimentul a implicat decesul sau amenin>area cumoartea în ca;ul unei persoane apropiate9 atuncie%enimentul a fost %iolent sau accidental.

A tr!i e=punerea repetat! sau e=trem! la detalii a%ersi%eale e%enimentului traumatic 7de e=. în ca;ul poli>iGtilor9pompierilor9 leFiGtilor etc8. De men>ionat c! acest criteriunu se aplic! în situa>iile de e=punere prin mass3media9computer9 lme9 cu e=cep>ia ca;ului în care e=punerea esteleFat! de acti%itatea profesional!.

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B P&4:+ + *+ 8+' 830 &'0&'' 2' &805+&+3'*0, +& '32 *'87058 9' *8 2 '0&4',2'*754':' >+0'1, 2'*5'&, 1'0+&, .'0+6'3'0+0,260+0 *+ +>&+1+0 27 1'80 0&+8+0'; S'87058 '0&4'1; amintiri &&0, '1530+&,

*7&05+&, '0&4'1, +3 1'803 0&+8+0'@ %isuri &&0 *7&05+&, 5:'0 *+ +0 3>+0 21'80@ reac>ii disociati%e (2 . +*-6+-&'), 0'873 &5&+ '2'1'23 * *'80 9' +:'5+4 + 9' 8

1'803 0&+8+0' +& +1+ 35 7&40@ disconfortpsihic intens sau prelunFit9 ori reac>ii ;ioloFicemarcate + &*7* 3+ *0'83' '0&'/.0&' +&*'8653'4+4 *+ *+8 +*70 +3 1'803'0&+8+0'@

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D'*754':' >+0'1; incapacitate persistent! dea tr!i emo>ii po;iti%e (2 . * 6&, &*'80 *+0'*+:'+, 75+0 '6')

S'87058 2'*5'+0'1; alterarea percep>ieirealit!>i' (2 . * 7&'190 2' ++&+ 5&73',*'80 0'873 * scurFe mai lent etc8Hincapacitatea 2 +-9' &+8'0' +*70 '875&0+0+3 1'803' 0&+8+0'

S'87058 2 1'0+&; eforturi de a e%itaamintiri9 Fnduri9 emo>ii 3>+0 2/ +*5'+0 2+7&5+7 1'803 0&+8+0'@ eforturi dea e%ita stimuli +& ' +0'1+4 '8+>'', >


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S'87058 2 .'0+6'3'0+0 &*0; tul:ur!ri de somn,comportament irita:il 9' &'4 2 &' ('+& &7&515+&), .7&'8+0 0'7' 7&' +>&*' 1&6+3 *+ =4'+: 2 7&*5+ *+ 56'0@ hiper%iFilen>!9 pro:lemede concentrare9 r!spuns de tres!rire e=aFerat.C D&+0+ 8+'*0&'35& 2 3+ 703 B *0 2 " 4'3 7


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D41530+&+ 5& *'87058 85:'5+3 9'5875&0+80+3 + &*7* 3+ +05& *0&*5&'20'=+6'3, +& +7+& 8+.'8 " 3' 2 3+2603 +:''' +*0' *0&*5&

A*0 *'87058 *+ 5875&0+80 *0*8'=+0'1 3'', 27 8 &430 2' 3 *++863 *'87058 2' 3'*0+ 2 8+' ?5*; D'*55&0 8+&+0 2'*7&575&:'5+0 +: 2

*1&'0+0+ 9' '0*'0+0+ *0&*5&3', 3


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P&0&6&'3 3>+0 2 +:'+ *0&*5&'35& 273'*

&'0&'' 70& +30 036&+& 80+3 9' *0 25+& 5.+&6+& + ' 036&&' 7*'' 7&.'*00

S'870583 &7&4'0 253' 5&8+3O2+0 *0&*5&3 *+ 5*':3 3' *-+ 0&8'+0,

*'87058 7&*'*0 7*0 3'

S7'=+:';- 2'*754':' 27&*'1; 2'*754':' *40, 73&'?5&+&, 3''90, +.'0+0 2*7+&+&

- +.'0+0 9' 2'*754':' 27&*'1; 7&258' 0+6358'.0, 2 +.'0+0 9' 27&*'- 7&0&6&' 2 52'0- 7&0&6&' 2 52'0 9' 85:'5+3-*7'=+0

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N)1I#NI DEMANA+EMEN**EA"E#*IC

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UNOR TRAUME SAU STRESORI


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*S"* ,I EAC1IA AC#*/ DE S*ES3ISS 7în special sertralina9 paro=etina8< prima linie detratament

3imipramina9 amitriptilina9 IMA)9 tra;odona9 car:ama;epina9%alproat3clonidina9 propranolol3haloperidol pentru perioadele de aFita>ie se%er! Gi aFresi%itate3psihoterapie@ psihodinamic!H comportamental!9 coFniti%!9hipno;!H terapii de FrupH

*#L'#/ILE DE ADA"*AE3psihoterapie@ de eelc>ieH terapie de Frup? indi%idual!H3:en;odia;epine pe termen scurtH psihostimulante în ca;ulformelor cu inhi:i>ieH antidepresi%e.

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Curs Studenti Psihofarma ANXIETATE 2016