![]() ![]() She was admitted to the Psychiatry department, and after a battery of exams we discovered that her thyroid function wasn’t yet normalized (TSH 0.012uUl/mL T4L 1.0ng/dL). In the emergency department her mental state examination identified expansive posture, overfamiliarity, disinhibition, distractibility, pressure of speech with flight of ideas, auditory hallucinations and persecutory delusion. had a background of depressive episodes, hypertension and hypothyroidism, and was medicated with paroxetine 20mg ½ cp id diazepam 10mg id trazodone 100mg id quetiapine 50mg id AAS 100mg id levothyroxine 0.1mg id and lisinopril 5mg id. He reported that these symptoms started after his wife was discharged from a three-day admission in an Internal Medicine department, twenty days earlier, due to hyponatremia, hypokalemia and iatrogenic hyperthyroidism (TSH<0.004uUl/mL T4L 2.1ng/dL, normal= 0.4-4.0uUl/mL 0.8-1.6ng/dL). M, 64 years, was brought to the psychiatry emergency department by her husband, who described behavioral changes characterized by leaving home during the night, decreased need for sleep, excessive talkativeness and mood elation. Psychosocial therapy was implemented through conducting psychoeducational trainings and training of solving interpersonal problems. The psychotherapeutic component was represented by the integrated use of rational psychotherapy, personality-oriented psychotherapy, and cognitive therapy. Pharmacotherapy of manic episode of bipolar affective disorder included the use of valproic acid salts, olanzapine when depressive episode - lamotrigine or valproic acid salts, quetiapine when mixed episode - valproic acid salts, aripiprazole. We have developed pathogenetically justified system for the prevention of autoaggressive behavior in patients with bipolar affective disorder, which included pharmacotherapy, psychotherapy and psychosocial therapy. It has been established that autoaggressive behavior in case of manic episode of bipolar affective disorder is associated with angry mania in case of depressive episode it is associated with sad depression, when mixed episode - with a combination of angry mania and anxious depression. Hyperbaric oxygen promotes generalized detoxification, improves metabolic, detoxification processes, promotes elimination of hypoxic factor, positively influences (stimulates functional activity of the cardiovascular system, including capillary), adding synergistic preconditions for plasmapheretic exfusion of toxins and harmful metabolites excreted in circulation. It has been proved that MPP pathogenetically provides intensive extracorporeal exfusion of toxic substances from circulating blood plasma. Aiming to increase significantly detoxification efficiency, our utility model “Method of intensive detoxification therapy in emergency states of narcotic genesis” (patent 24574, UA) provides membrane plasmapheresis (MPP) at minimized conventional pharmacotherapy with dosed 600.0-1000.0 ml blood exfusion, and hyperbaric oxygen therapy (HBO) 12-14 hours after the procedure, with 1.2-1.3 atm oxygen pressure in the chamber, and 45-60 minutes exposure every 3 days MPP procedure re-treatment (2-3 courses totally for a course), and a 3-5 session course of daily HBO.
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