Prezentari de caz - tratamentul alcoolicilor

PREZENTǍRI DE CAZ

Cazul IA

Date personale: B.A., 09.05.1955 (49 ani)

masculin, Sibiu, casatorit, pensionar, asigurat CNAS

Data internarii: 01.12.2004, ora 17:35

Data externarii: 24.12.2004

Motivele internarii: heteroagresivitate, tulburari de comportament la domiciliu, comportament dezadaptativ la consumul de alcool

Antecedente eredo-colaterale: tata alcoolic

Antecedente personale: ulcer, repetate internari la sectia de psihiatrie

Conditii de viata si munca: pensionat pe caz de boala, fumator, consumator de bauturi alcoolice

Istoricul bolii: pacient in varsta de 49 ani cu repetate internari in urma cu 3-4 ani, pensionat pe motive de boala psihica, este adus de ambulanta, insotit de asistenta si fiul sau, acesta declara ca tatal sau consuma cantitati de bauturi alcoolice, devenind violent verbal, avand insomnii si comportament heteroagresiv nocturn, recunoaste consumul de bauturi alcoolice fiind de acord cu internarea. Declarativ ultimul consum de bautura s-a facut la data internarii

Examen clinic general:

-   &nb 646b12g sp;   &nb 646b12g sp; stare generala - buna

-   &nb 646b12g sp;   &nb 646b12g sp; stare de con stienta - prezenta, clara

-   &nb 646b12g sp;   &nb 646b12g sp; facies obosit

-   &nb 646b12g sp;   &nb 646b12g sp; tegumente normal reprezentate

-   &nb 646b12g sp;   &nb 646b12g sp; mucoase conjunctive subicterice cu hiperemie

-   &nb 646b12g sp;   &nb 646b12g sp; fanere normale

-   &nb 646b12g sp;   &nb 646b12g sp; tesut adipos - relativ normal

-   &nb 646b12g sp;   &nb 646b12g sp; sistem ganglionar nepalpabil

-   &nb 646b12g sp;   &nb 646b12g sp; sistem muscular normoton, normokinetic

-   &nb 646b12g sp;   &nb 646b12g sp; sistem osteoarticular aparent integru morfofunctional

-   &nb 646b12g sp;   &nb 646b12g sp; aparat respirator torace conformatie normala, sonoritate pulmonara, murmur cular prezent

-   &nb 646b12g sp;   &nb 646b12g sp; aparat cardiovascular tratament cu produse apicole" class="text">cardiovascular tratament cu produse apicole" class="text">cardiovascular zgomote cardiace ritmice bine batute, AV = 90/min., TA = 150/90 mmHg

-   &nb 646b12g sp;   &nb 646b12g sp; aparat digestiv abdomen suplu la palpare, nedureros, ficat, splina nepalpabile

-   &nb 646b12g sp;   &nb 646b12g sp; aparat urogenital fara acuze, Giordano negativ bilateral

-   &nb 646b12g sp;   &nb 646b12g sp; sistem nervos, endocrin, organe de simt - ROT prezente, fara semne de iritatie meningeana, nu prezinta semne de focar

Examen psihiatric:

-   &nb 646b12g sp;   &nb 646b12g sp; mimica - nu realizeaza contact vizual cu medicul, priveste in jos

-   &nb 646b12g sp;   &nb 646b12g sp; tinuta vestimentara - adecvata

-   &nb 646b12g sp;   &nb 646b12g sp; atitudine partial cooperanta (raspunde lacunar, cu nemultumire si numai la unele intrebari, pare concentrat pe alte ganduri)

-   &nb 646b12g sp;   &nb 646b12g sp; contact verbal se stabileste cu dificultate

-   &nb 646b12g sp;   &nb 646b12g sp; constiinta - clara, prezenta, recunoaste partial consumul de bauturi alcoolice si faptele de care este acuzat de catre fiu

-   &nb 646b12g sp;   &nb 646b12g sp; orientare orientat temporospatial, auto si allopatic

-   &nb 646b12g sp;   &nb 646b12g sp; perceptia nu se poate aprecia (lipsa colaborare)

-   &nb 646b12g sp;   &nb 646b12g sp; atentia distrasa de ganduri proprii

-   &nb 646b12g sp;   &nb 646b12g sp; memoria nu se poate explora la momentul internarii

-   &nb 646b12g sp;   &nb 646b12g sp; gandirea flux ideativ coerent

-   &nb 646b12g sp;   &nb 646b12g sp; limbaj simplu, vag, concret

-   &nb 646b12g sp;   &nb 646b12g sp; intelect mediu

-   &nb 646b12g sp;   &nb 646b12g sp; afectivitate labilitate afectiv-emotionala, irascibilitate

-   &nb 646b12g sp;   &nb 646b12g sp; vointa si activitate voluntara - atitudine ostila fata de fiu, heteroagresivitate la domiciliu

-   &nb 646b12g sp;   &nb 646b12g sp; viata instinctuala - nemodificata

-   &nb 646b12g sp;   &nb 646b12g sp; ritm nictemeral insomnii, tulburari de comportament

-   &nb 646b12g sp;   &nb 646b12g sp; personalitate dizarmonica instabila, paranoica

Analize de laborator:

-   &nb 646b12g sp;   &nb 646b12g sp; leucocite 4500/m³

-   &nb 646b12g sp;   &nb 646b12g sp; hemoglobina 15 g/l

-   &nb 646b12g sp;   &nb 646b12g sp; hematocrit 43 m/s

-   &nb 646b12g sp;   &nb 646b12g sp; glicemie 202 mg/l

-   &nb 646b12g sp;   &nb 646b12g sp; uree 24 mg/l

-   &nb 646b12g sp;   &nb 646b12g sp; γGT 51UI/l

-   &nb 646b12g sp;   &nb 646b12g sp; TGO 111 UI/l

-   &nb 646b12g sp;   &nb 646b12g sp; TGP 86 UI/l

Diagnostic de trimitere adus de urgenta de ambulanta

Diagnostic la internare APM la domiciliu cu tendinte heteroagresive. Uz nociv pentru sanatate al alcoolului. Tulburare de personalitate predominant instabil emotionala cu tulburare de comportament

Diagnostic la 72 ore - Tulburare de personalitate predominant instabil emotionala. Consum de alcool nociv pentru sanatate

Diagnostic principal la externare - Uz nociv pentru sanatate al alcoolului. Tulburare de personalitate predominant instabil emotionala

Tratament:

-   &nb 646b12g sp;   &nb 646b12g sp; Meprobamat (400 mg) 1-l-l

-   &nb 646b12g sp;   &nb 646b12g sp; Carbamazepina 1/2- 1/2-l

-   &nb 646b12g sp;   &nb 646b12g sp; Vitamina B1, B6 1fiola/zi

-   &nb 646b12g sp;   &nb 646b12g sp; Tiapridal (100 mg) 1-l-0

-   &nb 646b12g sp;   &nb 646b12g sp; Metaspar 1-l-0

-   &nb 646b12g sp;   &nb 646b12g sp; Nifedipin 1-l-0

-   &nb 646b12g sp;   &nb 646b12g sp; Furosemid 1 fiola la nevoie i n caz de TA>180/100 mmHg

Sustinerea diagnosticului si tratamentului:

Clinic abuz etanolic, tulburare de comportament in cadrul intoxicatiei alcoolice, impulsivitate, agresivitate

Paraclinic sustinut de laborator

Epicriza - pacient cu antecedente psihiatrice se interneaza in urgenta in stare de APM in contextul intoxicatiei alcoolice acute. In prezenta personalului medical este iritabil, prezinta un control deficitar al emotiilor si comportamentului cu reactii disproportionate; are probleme de integrare socio-familiala datorita consumului abuziv de alcool

Sub tratamentul sedativ neuroleptic, hepatoprotector prezinta o evolutie favorabila.

Se externeaza cu recomandarile: respectarea masurilor de igiena si abstinenta la consumul de alcool

Tratament: Vitamine 1- 1-l si Meprobamat 0-0-l/2

Se indica prezentarea la control periodic.

Cazul IB

Date personale: B.A., 09.05.1955 (51 ani)

masculin, Sibiu, casatorit, pensionar, asigurat CNAS

Data internarii: 20.12.2006

Data externarii: 12.01.2007

Motivele internarii: consum zilnic de alcool in ultimele doua saptamani, oprirea consumului de 2 zile cu aparitia halucinatiilor vizuale, insomnii, transpiratii, tremor al extremitatilor

Antecedente eredo-colaterale: tata alcoolic

Antecedente personale: ulcer, repetate internari la sectia de psihiatrie

Conditii de viata si munca: pensionat pe caz de boala, fumator, consumator de bauturi alcoolice, medicamete adm. inaintea internarii (Meprobamat, 1 tb. Diazepam)

Istoricul bolii: pacient in varsta de 51 ani cu antecedente psihiatrice, adus de sotie si fiu, a consumat zilnic 2-3 l/zi; de doua zile a intrerupt consumul de alcool cu aparitia halucinatiilor vizuale, insomniilor si transpiratiilor nocturne, prezinta tremor al extremitatilor

Examen clinic general:

-   &nb 646b12g sp;   &nb 646b12g sp; stare generala - buna

-   &nb 646b12g sp;   &nb 646b12g sp; stare de con stienta - prezenta, clara

-   &nb 646b12g sp;   &nb 646b12g sp; facies obosit

-   &nb 646b12g sp;   &nb 646b12g sp; tegumente normal reprezentate

-   &nb 646b12g sp;   &nb 646b12g sp; mucoase normal reprezentate

-   &nb 646b12g sp;   &nb 646b12g sp; fanere normale

-   &nb 646b12g sp;   &nb 646b12g sp; tesut adipos - relativ normal

-   &nb 646b12g sp;   &nb 646b12g sp; sistem ganglionar nepalpabil

-   &nb 646b12g sp;   &nb 646b12g sp; sistem muscular normoton, normokinetic

-   &nb 646b12g sp;   &nb 646b12g sp; sistem osteoarticular aparent integru morfofunctional

-   &nb 646b12g sp;   &nb 646b12g sp; aparat respirator torace conformatie normala, sonoritate pulmonara, murmur cular prezent

-   &nb 646b12g sp;   &nb 646b12g sp; aparat cardiovascular tratament cu produse apicole" class="text">cardiovascular tratament cu produse apicole" class="text">cardiovascular zgomote cardiace ritmice bine batute, AV = 90/min., TA = 140/90 mmHg

-   &nb 646b12g sp;   &nb 646b12g sp; aparat digestiv abdomen suplu la palpare, nedureros, ficat, splina nepalpabile

-   &nb 646b12g sp;   &nb 646b12g sp; aparat urogenital fara acuze, Giordano negativ bilateral

-   &nb 646b12g sp;   &nb 646b12g sp; sistem nervos, endocrin, organe de simt - ROT prezente, fara semne de iritatie meningeana, nu prezinta semne de focar, tumora de timus operata

Examen psihiatric:

-   &nb 646b12g sp;   &nb 646b12g sp; mimica - expresiva

-   &nb 646b12g sp;   &nb 646b12g sp; tinuta vestimentara - adecvata

-   &nb 646b12g sp;   &nb 646b12g sp; atitudine cooperanta, accepta internarea

-   &nb 646b12g sp;   &nb 646b12g sp; contact verbal bun

-   &nb 646b12g sp;   &nb 646b12g sp; constiinta - clara, prezenta

-   &nb 646b12g sp;   &nb 646b12g sp; orientare orientat temporospatial, auto si allopatic

-   &nb 646b12g sp;   &nb 646b12g sp; perceptia normala

-   &nb 646b12g sp;   &nb 646b12g sp; atentia fara modificari

-   &nb 646b12g sp;   &nb 646b12g sp; memoria fara modificari semnificative

-   &nb 646b12g sp;   &nb 646b12g sp; gandirea ritmica, coerenta, recunoaste consumul de alcool

-   &nb 646b12g sp;   &nb 646b12g sp; limbaj corect

-   &nb 646b12g sp;   &nb 646b12g sp; intelect slab

-   &nb 646b12g sp;   &nb 646b12g sp; afectivitate fara modificari

-   &nb 646b12g sp;   &nb 646b12g sp; vointa si activitate voluntara - in limite normale

-   &nb 646b12g sp;   &nb 646b12g sp; viata instinctuala - nemodificata

-   &nb 646b12g sp;   &nb 646b12g sp; ritm nictemeral insomnii

-   &nb 646b12g sp;   &nb 646b12g sp; personalitate dizarmonica instabila, cu halucinatii vizuale

Analize de laborator:

-   &nb 646b12g sp;   &nb 646b12g sp; γGT 260UI/l

-   &nb 646b12g sp;   &nb 646b12g sp; TGO 203 UI/l

-   &nb 646b12g sp;   &nb 646b12g sp; TGP 135 UI/l

-   &nb 646b12g sp;   &nb 646b12g sp; Glicemie 95 mg%

-   &nb 646b12g sp;   &nb 646b12g sp; Uree 30 mg%

-   &nb 646b12g sp;   &nb 646b12g sp; Leucocite 5400 mm³

Diagnostic de trimitere suspect delirium tremens

Diagnostic la internare Stare de sevraj la nicotina) - fumatul" class="text">sevraj cu delir, sindrom de dependenta etanolica

Diagnostic la 72 ore - Stare de sevraj cu delir, sindrom de dependenta etanolica

Diagnostic principal la externare Sindrom de dependenta la alcool; Stare de sevraj complicat cu delirium tremens

Diagnostice secundare la externare: Hepatita cronica etanolica, HTA oscilanta

Tratament:

-   &nb 646b12g sp;   &nb 646b12g sp; Meprobamat (400 mg) 1-l-l

-   &nb 646b12g sp;   &nb 646b12g sp; Diazepam 1 fiola seara

-   &nb 646b12g sp;   &nb 646b12g sp; Vitamina B1, B6 1fiola/zi

-   &nb 646b12g sp;   &nb 646b12g sp; Tiapridal (100 mg) 1-l-0

-   &nb 646b12g sp;   &nb 646b12g sp; Silimarina 1-l-l

Sustinerea diagnosticului si tratamentului:

Clinic abuz etanolic, tulburare de comportament in cadrul intoxicatiei alcoolice, halucinatii vizuale

Paraclinic sustinut de laborator

Epicriza - pacient in evidenta psihiatrica revine in urgenta cu un tablou dominat de halucinatii vizuale, tulburari neurovegetative, insomnii mixte, simptomatologic afirmate pe fondul unui consum cronic de alcool intrerupt cu 2 zile inaintea aparitiei acuzelor. In timpul internarii beneficiaza de terapie sedativa, neuroleptica si hepatoprotectoare. Evolutie spre ameliorare cu repetarea transaminazelor dupa 2 saptamani cu urmatoarele valori:

-   &nb 646b12g sp;   &nb 646b12g sp; TGO 18 UI/l

-   &nb 646b12g sp;   &nb 646b12g sp; TGP 47 UI/l

Se externeaza cu recomandarile: respectarea masurilor de igiena si abstinenta la consumul de alcool

Tratament: Meprobamat 1-l-l, Diazepam 0-0-l, Mecofen 1-l-l, Silimarina 1-0-0

Se indica prezentarea la control periodic.

Cazul II A

Date personale: H. I., 18.11.1951,54 ani. Sibiu,Sibiu

masculin, casatorit, muncitor (electrician)

Data internarii: 04.02.2005

Data externarii: 21.02.2005

Motivele internarii: consum zilnic de alcool 800-l000 ml tarie, tremor al extremitatilor

Antecedente eredo-colaterale: fara importanta

Antecedente personale: fara importanta

Conditii de viata si munca: pensionat pe caz de boala, consumator de bauturi alcoolice

Istoricul bolii: pacient la a 12-a internare in psihiatrie din 1995, precedenta in anul trecut, relateaza ca de aproximativ 2-3 luni a reluat consumul de alcool ajungand in ultima perioada la 1 l/zi, prezinta tremor al extremitatilor dimineata la trezire si nevoia de a consuma alcool, tremorul disparand dupa ingestia acestuia. Ultimul consum in seara zile de 02.02.2005

Examen clinic general:

-   &nb 646b12g sp;   &nb 646b12g sp; stare generala - buna

-   &nb 646b12g sp;   &nb 646b12g sp; stare de constienta - clara

-   &nb 646b12g sp;   &nb 646b12g sp; facies incercanat

-   &nb 646b12g sp;   &nb 646b12g sp; tegumente transpirate, palide

-   &nb 646b12g sp;   &nb 646b12g sp; mucoase normal colorate

-   &nb 646b12g sp;   &nb 646b12g sp; fanere normale

-   &nb 646b12g sp;   &nb 646b12g sp; tesut adipos - relativ normal

-   &nb 646b12g sp;   &nb 646b12g sp; sistem ganglionar nepalpabil

-   &nb 646b12g sp;   &nb 646b12g sp; sistem muscular hipoton

-   &nb 646b12g sp;   &nb 646b12g sp; sistem osteoarticular aparent integru morfofunctional

-   &nb 646b12g sp;   &nb 646b12g sp; aparat respirator torace conformatie normala, sonoritate pulmonara, murmur cular prezent

-   &nb 646b12g sp;   &nb 646b12g sp; aparat cardiovascular tratament cu produse apicole" class="text">cardiovascular tratament cu produse apicole" class="text">cardiovascular zgomote cardiace ritmice bine batute, AV = 90/min., TA = 140/90 mmHg

-   &nb 646b12g sp;   &nb 646b12g sp; aparat digestiv abdomen suplu la palpare, nedureros, ficat, splina nepalpabile

-   &nb 646b12g sp;   &nb 646b12g sp; aparat urogenital fara acuze, Giordano negativ bilateral

-   &nb 646b12g sp;   &nb 646b12g sp; sistem nervos, endocrin, organe de simt - ROT prezente, fara semne de iritatie meningeana, nu prezinta semne de focar, tremor al extremitatilor

Examen psihiatric:

-   &nb 646b12g sp;   &nb 646b12g sp; mimica - mobila, expresiva, facies incercanat, gestica adecvata, contact vizual prezent

-   &nb 646b12g sp;   &nb 646b12g sp; tinuta vestimentara - adecvata

-   &nb 646b12g sp;   &nb 646b12g sp; atitudine cooperanta

-   &nb 646b12g sp;   &nb 646b12g sp; contact verbal facil

-   &nb 646b12g sp;   &nb 646b12g sp; con stiinta - clara, boala psihica perceputa

-   &nb 646b12g sp;   &nb 646b12g sp; orientare orientat temporospatial, auto si allopatic

-   &nb 646b12g sp;   &nb 646b12g sp; perceptia normala

-   &nb 646b12g sp;   &nb 646b12g sp; atentia scazuta

-   &nb 646b12g sp;   &nb 646b12g sp; memoria hipomnezie de fixare

-   &nb 646b12g sp;   &nb 646b12g sp; gandirea ritm si flux ideativ mai lent, coerent, recunoaste consumul de alcool

-   &nb 646b12g sp;   &nb 646b12g sp; limbaj corect

-   &nb 646b12g sp;   &nb 646b12g sp; intelect slab

-   &nb 646b12g sp;   &nb 646b12g sp; afectivitate anxietate, stare de iritabilitate

-   &nb 646b12g sp;   &nb 646b12g sp; vointa si activitate voluntara - comportament de toxicofil, tremor al extremitatilor

-   &nb 646b12g sp;   &nb 646b12g sp; viata instinctuala - apetit alimentar in diabetul zaharat" class="text">alimentar scazut

-   &nb 646b12g sp;   &nb 646b12g sp; ritm nictemeral afirmativ pastrat

-   &nb 646b12g sp;   &nb 646b12g sp; personalitate dizarmonica structurata

Analize de laborator:

-   &nb 646b12g sp;   &nb 646b12g sp; γGT 329 UI/l

-   &nb 646b12g sp;   &nb 646b12g sp; TGO 52 UI/l

-   &nb 646b12g sp;   &nb 646b12g sp; TGP 30 UI/l

-   &nb 646b12g sp;   &nb 646b12g sp; Glicemie 87 mg%

-   &nb 646b12g sp;   &nb 646b12g sp; VSH 30 mm/h

Diagnostic de trimitere Tulburare depresiva, anxioasa, accentuata pe fond de etilism cronic

Diagnostic la internare Stare de sevraj, sindrom de dependenta etanolica

Diagnostic la 72 ore - Stare de sevraj, sindrom de dependenta etanolica

Diagnostic principal la externare Stare de sevraj etanolic, Sindrom de dependenta etanolica

Diagnostice secundare la externare: Tulburare de personalitate endo-exogena, comitialitate secundara GM, hepatita cronica etanolica, HTA stadiul II.

Tratament:

-   &nb 646b12g sp;   &nb 646b12g sp; Meprobamat 2 tb/6 ore

-   &nb 646b12g sp;   &nb 646b12g sp; Diazepam 1 fiola seara

-   &nb 646b12g sp;   &nb 646b12g sp; Metaspar 1-l-l

-   &nb 646b12g sp;   &nb 646b12g sp; Carbamazepina 1/2-0-l/2

Sustinerea diagnosticului si tratamentului:

Clinic abuz etanolic

Paraclinic sustinut de laborator

Epicriza - pacient la a 12-a internare in psihiatrie, cunoscut consumator de alcool, revine pentru un tablou psihopatologic interpretat pe baza anamnezei antecedentelor psihiatrice si examenul psihic actual in cadrul unei stari de sevraj etanolic pe finalul unui sindrom de dependenta etanolica si a unei tulburari de personalitate de etiologie endo-exogena.

Din punct de vedere somatic prezinta comitialitate secundara GM, hepatita cronica etanolica, HTA stadiul II.

A urmat tratament anxiolitic psihostimulant, anticomitial, prezentand o evolutie favorabila

Se externeaza cu recomandarile: respectarea masurilor de psiho-igiena si abstinenta la consumul de alcool

Tratament: Meprobamat 0-0-l, Carbamazepina 1/2-l/2-l

Se indica control prin ambulator de specialitate

Cazul II B

Date personale: H. I., 18.11.1951,56 ani. Sibiu,Sibiu

masculin, divortat, pensionar, asigurat CNAS

Data internarii: 03.12.2007

Data externarii: 21.12.2007

Motivele internarii: dependenta la alcool cu intreruperea consumului de 1-2 zile, stari confuzionale, agitatie psiho-motorie, comportament dezadaptativ

Antecedente eredo-colaterale: fara importanta

Antecedente personale: fara importanta

Conditii de viata si munca: pensionat pe caz de boala, consumator de bauturi alcoolice

Istoricul bolii: bolnav cu numeroase internari datorita consumului abuziv de alcool de aproximativ 10 ani, a fost adus de urgenta de familie datorita tulburarilor asociate intreruperii acestuia

Examen clinic general:

-   &nb 646b12g sp;   &nb 646b12g sp; stare generala - buna

-   &nb 646b12g sp;   &nb 646b12g sp; stare de constienta - clara

-   &nb 646b12g sp;   &nb 646b12g sp; facies incercanat

-   &nb 646b12g sp;   &nb 646b12g sp; tegumente transpirate, palide

-   &nb 646b12g sp;   &nb 646b12g sp; mucoase normal colorate

-   &nb 646b12g sp;   &nb 646b12g sp; fanere normale

-   &nb 646b12g sp;   &nb 646b12g sp; tesut adipos - relativ normal

-   &nb 646b12g sp;   &nb 646b12g sp; sistem ganglionar nepalpabil

-   &nb 646b12g sp;   &nb 646b12g sp; sistem muscular hipoton

-   &nb 646b12g sp;   &nb 646b12g sp; sistem osteoarticular aparent integru morfofunctional

-   &nb 646b12g sp;   &nb 646b12g sp; aparat respirator torace conformatie normala, sonoritate pulmonara, murmur cular prezent, dispnee de efort

-   &nb 646b12g sp;   &nb 646b12g sp; aparat cardiovascular tratament cu produse apicole" class="text">cardiovascular tratament cu produse apicole" class="text">cardiovascular zgomote cardiace ritmice bine batute, AV = 90/min., TA = 110/80 mmHg

-   &nb 646b12g sp;   &nb 646b12g sp; aparat digestiv abdomen suplu la palpare, nedureros, hepatita cronica

-   &nb 646b12g sp;   &nb 646b12g sp; aparat urogenital tulburari de mictiune

-   &nb 646b12g sp;   &nb 646b12g sp; sistem nervos, endocrin, organe de simt - ROT prezente, fara semne de iritatie meningeana, nu prezinta semne de focar, tremor al extremitatilor, polineurita carentiala

Examen psihiatric:

-   &nb 646b12g sp;   &nb 646b12g sp; mimica - neexpresiva

-   &nb 646b12g sp;   &nb 646b12g sp; tinuta vestimentara - neingrijita

-   &nb 646b12g sp;   &nb 646b12g sp; atitudine necooperanta

-   &nb 646b12g sp;   &nb 646b12g sp; contact verbal nu se poate stabili

-   &nb 646b12g sp;   &nb 646b12g sp; con stiinta - nu are con stinta bolii

-   &nb 646b12g sp;   &nb 646b12g sp; orientare dezorientat temporospatial

-   &nb 646b12g sp;   &nb 646b12g sp; perceptia scazuta

-   &nb 646b12g sp;   &nb 646b12g sp; atentia scazuta

-   &nb 646b12g sp;   &nb 646b12g sp; memoria tulburari de memorie

-   &nb 646b12g sp;   &nb 646b12g sp; gandirea incoerenta, halucinatii vizuale

-   &nb 646b12g sp;   &nb 646b12g sp; limbaj incoerent

-   &nb 646b12g sp;   &nb 646b12g sp; intelect slab

-   &nb 646b12g sp;   &nb 646b12g sp; afectivitate anxietate, stare de iritabilitate

-   &nb 646b12g sp;   &nb 646b12g sp; vointa si activitate voluntara - comportament de toxicofil, tremor al extremitatilor

-   &nb 646b12g sp;   &nb 646b12g sp; viata instinctuala - aproape absenta

-   &nb 646b12g sp;   &nb 646b12g sp; ritm nictemeral insomnii

-   &nb 646b12g sp;   &nb 646b12g sp; personalitate dizarmonica structurata

Analize de laborator:

-   &nb 646b12g sp;   &nb 646b12g sp; γGT 60 UI/l

-   &nb 646b12g sp;   &nb 646b12g sp; TGO 48 UI/l

-   &nb 646b12g sp;   &nb 646b12g sp; TGP 32 UI/l

-   &nb 646b12g sp;   &nb 646b12g sp; Glicemie 139 mg%

-   &nb 646b12g sp;   &nb 646b12g sp; Creatinina 1,16 mg%

-   &nb 646b12g sp;   &nb 646b12g sp; HGB 11g%

-   &nb 646b12g sp;   &nb 646b12g sp; HT 31,1%

-   &nb 646b12g sp;   &nb 646b12g sp; Leucocite 9,7/mm³

Diagnostic la internare Sindrom de dependenta etanolica, stare de sevraj complicat cu delir

Diagnostic la 72 ore - Stare de sevraj etanolic complicat cu delirium tremens, sindrom de dependenta etanolica

Diagnostic principal la externare Stare de sevraj etanolic complicat cu delirium tremens, sindrom de dependenta etanolica

Diagnostice secundare la externare: Tulburare organica de personalitate, polineuropatie periferica toxic carentiala, hepatita cronica etanolica, comitialitate GM secundara

Tratament:

-   &nb 646b12g sp;   &nb 646b12g sp; Meprobamat 2-2-2

-   &nb 646b12g sp;   &nb 646b12g sp; Diazepam 0-0-l

-   &nb 646b12g sp;   &nb 646b12g sp; Tiapridal 1/2-l/2-l

-   &nb 646b12g sp;   &nb 646b12g sp; Carbamazepina 1/2-l/2-l

-   &nb 646b12g sp;   &nb 646b12g sp; Milgamma 1-l-l sau 1 fiola/zi

-   &nb 646b12g sp;   &nb 646b12g sp; Silimarina 1-l-l

Sustinerea diagnosticului si tratamentului:

Clinic abuz etanolic

Paraclinic sustinut de laborator

Epicriza - pacient cu antecedente psihiatrice din 1995 se prezinta in regim de urgenta pentru o fenomenologie manifestata prin stare oniro-confuziva, stare de agitatie psiho-motorie, comportament dezorganizat, tremor generalizat, insomnii mixte pe fondul sevrajului etanolic la un consumator cronic si abuziv de bauturi alcoolice pe fondul unei tulburari organice de personalitate.

Pe parcursul spitalizarii pacientul beneficiaza de terapie sedativ hipnotica, anticomitiala, neuroleptica sedativa, hepatoprotectoare, consiliere cu evolutie lent favorabila.

Se externeaza cu recomandarile: interzicerea consumului de bauturi, climat psihoprotectiv in mediul socio-familial, control periodic si al afectiunilor somatice.

Tratament: Carbamazepina 1/2-l/2-l si Tiapridal 1/2-l/2-l

Cazul III A

Date personale: C. S., 09.05.1962,43 ani. Sibiu,Sibiu

masculin, necasatorit, pensionar

Data internarii: 03.02.2005

Data externarii: 18.02.2005

Motivele internarii: stare de neliniste psiho-motorie, tremor al extremitatilor, inapetenta, consum abuziv de alcool

Antecedente eredo-colaterale: fara importanta

Antecedente personale: ulcer

Conditii de viata si munca: pensionat pe caz de boala, consumator de bauturi alcoolice, fumator

Istoricul bolii: pacient in varsta de 43 ani, cu repetate internari in sectia de psihiatrie, a fost adus de apartinatori datorita consumului abuziv de alcool si a tulburarilor asociate acestuia.

Examen clinic general:

-   &nb 646b12g sp;   &nb 646b12g sp; stare generala - buna

-   &nb 646b12g sp;   &nb 646b12g sp; stare de constienta prezenta

-   &nb 646b12g sp;   &nb 646b12g sp; facies incercanat

-   &nb 646b12g sp;   &nb 646b12g sp; tegumente palide

-   &nb 646b12g sp;   &nb 646b12g sp; mucoase uscate

-   &nb 646b12g sp;   &nb 646b12g sp; fanere normale

-   &nb 646b12g sp;   &nb 646b12g sp; tesut adipos - relativ normal

-   &nb 646b12g sp;   &nb 646b12g sp; sistem ganglionar nepalpabil

-   &nb 646b12g sp;   &nb 646b12g sp; sistem muscular normoton

-   &nb 646b12g sp;   &nb 646b12g sp; sistem osteoarticular aparent integru morfofunctional

-   &nb 646b12g sp;   &nb 646b12g sp; aparat respirator torace conformatie normala, sonoritate pulmonara, murmur cular prezent

-   &nb 646b12g sp;   &nb 646b12g sp; aparat cardiovascular tratament cu produse apicole" class="text">cardiovascular tratament cu produse apicole" class="text">cardiovascular zgomote cardiace ritmice bine batute, AV = 90/min., TA = 130/100 mmHg

-   &nb 646b12g sp;   &nb 646b12g sp; aparat digestiv abdomen suplu la palpare, nedureros, ficat, splina nepalpabile

-   &nb 646b12g sp;   &nb 646b12g sp; aparat urogenital fara acuze, Giordano negativ bilateral

-   &nb 646b12g sp;   &nb 646b12g sp; sistem nervos, endocrin, organe de simt - ROT prezente, fara semne de iritatie meningeana, nu prezinta semne de focar, tremor al extremitatilor

Examen psihiatric:

-   &nb 646b12g sp;   &nb 646b12g sp; mimica - expresiva, facies incercanat, gestica adecvata, contact vizual prezent

-   &nb 646b12g sp;   &nb 646b12g sp; tinuta vestimentara - adecvata

-   &nb 646b12g sp;   &nb 646b12g sp; atitudine partial cooperanta

-   &nb 646b12g sp;   &nb 646b12g sp; contact verbal se stabileste cu dificultate

-   &nb 646b12g sp;   &nb 646b12g sp; con stiinta - clara, boala psihica perceputa

-   &nb 646b12g sp;   &nb 646b12g sp; orientare orientat temporospatial, auto si allopatic

-   &nb 646b12g sp;   &nb 646b12g sp; perceptia normala

-   &nb 646b12g sp;   &nb 646b12g sp; atentia scazuta

-   &nb 646b12g sp;   &nb 646b12g sp; memoria hipomnezie de fixare

-   &nb 646b12g sp;   &nb 646b12g sp; gandirea ritm si flux ideativ mai lent, coerent, recunoaste consumul de alcool

-   &nb 646b12g sp;   &nb 646b12g sp; limbaj corect

-   &nb 646b12g sp;   &nb 646b12g sp; intelect mediu

-   &nb 646b12g sp;   &nb 646b12g sp; afectivitate anxietate, stare de iritabilitate

-   &nb 646b12g sp;   &nb 646b12g sp; vointa si activitate voluntara in limite normale

-   &nb 646b12g sp;   &nb 646b12g sp; viata instinctuala - nemodificat

-   &nb 646b12g sp;   &nb 646b12g sp; ritm nictemeral insomnii

-   &nb 646b12g sp;   &nb 646b12g sp; personalitate dizarmonica structurata

Analize de laborator:

-   &nb 646b12g sp;   &nb 646b12g sp; γGT 360 UI/l

-   &nb 646b12g sp;   &nb 646b12g sp; TGO 215 UI/l

-   &nb 646b12g sp;   &nb 646b12g sp; TGP 130 UI/l

-   &nb 646b12g sp;   &nb 646b12g sp; Glicemie 100 mg%

-   &nb 646b12g sp;   &nb 646b12g sp; Leucocite 5500 mm³

Diagnostic de trimitere Sindrom de dependenta etanolica

Diagnostic la internare Sindrom de dependenta etanolica episod depresiv reactiv, tulburare de personalitate

Diagnostic la 72 ore - Stare de sevraj, sindrom de dependenta etanolica

Diagnostic principal la externare Stare de sevraj etanolic, Sindrom de dependenta etanolica

Diagnostice secundare la externare: Hepatopatie toxica

Tratament:

-   &nb 646b12g sp;   &nb 646b12g sp; Meprobamat 2 tb/6 ore

-   &nb 646b12g sp;   &nb 646b12g sp; Tapridal 1 -l-0

-   &nb 646b12g sp;   &nb 646b12g sp; Silimarina 1-l-l

-   &nb 646b12g sp;   &nb 646b12g sp; Diazepam 1fiola seara

Sustinerea diagnosticului si tratamentului:

Clinic tulburare de comportament in cadrul sindromului de dependenta etanolica

Paraclinic sustinut de laborator

Epicriza - pacient in evidenta psihiatrica, revine in urgenta cu un tablou dominat de stare de neliniste psiho-motorie, tremor al extremitatilor, inapetenta, consum abuziv de alcool

In timpul internarii beneficiaza de terapie sedativa, neuroleptica si hepatoprotectoare.

Se externeaza cu recomandarile: respectarea masurilor de psiho-igiena si abstinenta la consumul de alcool

Tratament: Meprobamat 0-0-l, Silimarina 1-0-0

Se indica control prin ambulator de specialitate

Cazul III B

Date personale: C. S., 09.05.1962,45 ani. Sibiu,Sibiu

masculin, necasatorit, pensionar

Data internarii: 03.10.2007

Data externarii: 18.10.2007

Motivele internarii: somn indus medicamentos, labilitate psiho-emotionala cu dificultate de adaptare si relationare

Antecedente eredo-colaterale: fara importanta

Antecedente personale: ulcer, hepatopatie cronica

Conditii de viata si munca: pensionat pe caz de boala, consumator de bauturi alcoolice, fumator

Istoricul bolii: pacient in varsta de 45 ani, cu repetate internari in sectia de psihiatrie, a fost adus de apartinatori in stare de inconstienta

Examen clinic general:

-   &nb 646b12g sp;   &nb 646b12g sp; stare generala - alterata

-   &nb 646b12g sp;   &nb 646b12g sp; stare de constienta absenta

-   &nb 646b12g sp;   &nb 646b12g sp; facies palid

-   &nb 646b12g sp;   &nb 646b12g sp; tegumente palide

-   &nb 646b12g sp;   &nb 646b12g sp; mucoase uscate

-   &nb 646b12g sp;   &nb 646b12g sp; fanere normale

-   &nb 646b12g sp;   &nb 646b12g sp; tesut adipos - relativ normal

-   &nb 646b12g sp;   &nb 646b12g sp; sistem ganglionar nepalpabil

-   &nb 646b12g sp;   &nb 646b12g sp; sistem muscular normoton

-   &nb 646b12g sp;   &nb 646b12g sp; sistem osteoarticular aparent integru morfofunctional

-   &nb 646b12g sp;   &nb 646b12g sp; aparat respirator torace conformatie normala, sonoritate pulmonara, murmur cular diminuat

-   &nb 646b12g sp;   &nb 646b12g sp; aparat cardiovascular tratament cu produse apicole" class="text">cardiovascular tratament cu produse apicole" class="text">cardiovascular zgomote cardiace ritmice bine batute, AV = 80/min., TA = 90/70 mmHg

-   &nb 646b12g sp;   &nb 646b12g sp; aparat digestiv abdomen suplu la palpare, nedureros, ficat palpabil

-   &nb 646b12g sp;   &nb 646b12g sp; aparat urogenital fara acuze, Giordano negativ bilateral

-   &nb 646b12g sp;   &nb 646b12g sp; sistem nervos, endocrin, organe de simt - ROT absente

Examen psihiatric:

-   &nb 646b12g sp;   &nb 646b12g sp; mimica neexpresiva

-   &nb 646b12g sp;   &nb 646b12g sp; tinuta vestimentara - inadecvata

-   &nb 646b12g sp;   &nb 646b12g sp; atitudine absenta

-   &nb 646b12g sp;   &nb 646b12g sp; contact verbal nu se realizeaza

-   &nb 646b12g sp;   &nb 646b12g sp; constiinta - absenta

-   &nb 646b12g sp;   &nb 646b12g sp; orientare absenta

-   &nb 646b12g sp;   &nb 646b12g sp; perceptia alterata

-   &nb 646b12g sp;   &nb 646b12g sp; atentia alterata

-   &nb 646b12g sp;   &nb 646b12g sp; memoria nu se poate stabili

-   &nb 646b12g sp;   &nb 646b12g sp; gandirea nu se poate stabili

-   &nb 646b12g sp;   &nb 646b12g sp; limbaj absent

-   &nb 646b12g sp;   &nb 646b12g sp; intelect neprecizabil

-   &nb 646b12g sp;   &nb 646b12g sp; afectivitate neprecizabila

-   &nb 646b12g sp;   &nb 646b12g sp; vointa si activitate voluntara comportament de toxicofil

-   &nb 646b12g sp;   &nb 646b12g sp; viata instinctuala - modificata

-   &nb 646b12g sp;   &nb 646b12g sp; ritm nictemeral insomnii

-   &nb 646b12g sp;   &nb 646b12g sp; personalitate de tip polimorf, anxios, evitant, dependent

Analize de laborator:

-   &nb 646b12g sp;   &nb 646b12g sp; γGT 460 UI/l

-   &nb 646b12g sp;   &nb 646b12g sp; TGO 230 UI/l

-   &nb 646b12g sp;   &nb 646b12g sp; TGP 140 UI/l

-   &nb 646b12g sp;   &nb 646b12g sp; Glicemie 200 mg%

-   &nb 646b12g sp;   &nb 646b12g sp; Leucocite 5500 mm³

Diagnostic de trimitere Politoxicomanie

Diagnostic la internare Politoxicomanie, tulburare de personalitate de tip polimorf

Diagnostic la 72 ore - Politoxicomanie, tulburare de personalitate de tip polimorf

Diagnostic principal la externare Sindrom de dependenta etanolica, Politoxicomanie, tulburare de personalitate de tip polimorf

Diagnostice secundare la externare: Hepatopatie toxica

Tratament:

-   &nb 646b12g sp;   &nb 646b12g sp; Tapridal 1 -l-0

-   &nb 646b12g sp;   &nb 646b12g sp; Taver

-   &nb 646b12g sp;   &nb 646b12g sp; Seroxat

-   &nb 646b12g sp;   &nb 646b12g sp; Imovane

-   &nb 646b12g sp;   &nb 646b12g sp; Silimarina 1-l-l

Sustinerea diagnosticului si tratamentului:

Clinic abuz de alcool, hipnotice si sedative

Paraclinic sustinut de laborator

Epicriza - pacient in evidenta psihiatrica, revine in urgenta cu un tablou de politoxicomanie

Evolutie spre ameliorare

Se externeaza cu recomandarile: respectarea masurilor de psiho-igiena si abstinenta la consumul de alcool

Tratament: Meprobamat 0-0-l, Silimarina 1-0-0

Se indica control prin ambulator de specialitate