{"id":18672,"date":"2014-12-01T10:49:09","date_gmt":"2014-12-01T09:49:09","guid":{"rendered":"http:\/\/www.invarena.cz\/?p=18672"},"modified":"2014-12-01T12:43:17","modified_gmt":"2014-12-01T11:43:17","slug":"pece-u-nas-je-stejne-kvalitni-jako-v-nejvyspelejsich-zemich-ale-neni-komplexni","status":"publish","type":"post","link":"https:\/\/www.invarena.cz\/?p=18672","title":{"rendered":"P\u00e9\u010de u n\u00e1s je stejn\u011b kvalitn\u00ed jako v nejvysp\u011blej\u0161\u00edch zem\u00edch, ale nen\u00ed komplexn\u00ed"},"content":{"rendered":"

Rozhovor s psychiatrem MUDr. Ivanem Davidem, b\u00fdval\u00fdm ministrem zdravotnictv\u00ed. O schizofrenii, legislativ\u011b a \u00fastavn\u00ed i n\u00e1sledn\u00e9 p\u00e9\u010di.<\/strong><\/p>\n

– P\u0159\u00edpad zavra\u017ed\u011bn\u00ed studenta ve \u017d\u010f\u00e1ru nad S\u00e1zavou vyvolal mnoho emoc\u00ed, kter\u00e9 byly zam\u00ed\u0159eny na o\u0161et\u0159uj\u00edc\u00ed psychiatry. I do na\u0161\u00ed redakce do\u0161ly velmi kritick\u00e9 hlasy t\u00edmto sm\u011brem. Jak\u00fd je v\u00e1\u0161 n\u00e1zor?<\/p>\n

Podle toho, jak\u00e1 se pr\u00e1v\u011b prob\u00edr\u00e1 af\u00e9ra, od n\u00e1s ob\u010dan\u00e9 cht\u011bj\u00ed jen dv\u011b v\u011bci: abychom nikoho do \u00fastavu nezav\u00edrali, anebo abychom nikoho nepropou\u0161t\u011bli. Psychiat\u0159i v psychiatrick\u00e9 nemocnici v Opav\u011b ve skute\u010dnosti odvedli v\u00fdbornou pr\u00e1ci. Stav nemocn\u00e9 se po m\u011bs\u00edc\u00edch \u00fasil\u00ed natolik zlep\u0161il, \u017ee mohla b\u00fdt propu\u0161t\u011bna do ambulantn\u00ed p\u00e9\u010de. Je ot\u00e1zkou, nakolik mohl ambulantn\u00ed psychiatr v\u010das rozpoznat zhor\u0161en\u00ed stavu, k n\u011bmu\u017e do\u0161lo n\u011bkolik m\u011bs\u00edc\u016f po propu\u0161t\u011bn\u00ed.
\nOsobn\u011b se domn\u00edv\u00e1m, \u017ee v podobn\u00fdch p\u0159\u00edpadech by byl vhodn\u00fdm \u0159e\u0161en\u00edm denn\u00ed stacion\u00e1\u0159, do kter\u00e9ho by nemocn\u00e1 po propu\u0161t\u011bn\u00ed doch\u00e1zela z domova a byla by pod mnohem lep\u0161\u00ed kontrolou ne\u017e v ambulantn\u00ed p\u00e9\u010di. Poji\u0161\u0165ovny v\u0161ak o takov\u00e9 form\u011b l\u00e9\u010den\u00ed (a dohledu) necht\u011bj\u00ed ani sly\u0161et. Finan\u010dn\u00ed hodnocen\u00ed, kter\u00e9 nab\u00edzej\u00ed, neumo\u017e\u0148uje p\u00e9\u010di ve stacion\u00e1\u0159\u00edch v\u016fbec provozovat.<\/p>\n

– Jin\u00ed v t\u00e9 souvislosti kritizuj\u00ed i soudce, jen\u017e vlastn\u011b vra\u017eedkyni dal zelenou. Bylo v jeho sil\u00e1ch trag\u00e9dii zabr\u00e1nit?<\/p>\n

To je zvl\u00e1\u0161t\u011b hloup\u00fd n\u00e1zor. Pro pokra\u010dov\u00e1n\u00ed \u00fastavn\u00ed ochrann\u00e9 l\u00e9\u010dby nebyl \u017e\u00e1dn\u00fd d\u016fvod a soud se mus\u00ed samoz\u0159ejm\u011b spolehnout na posouzen\u00ed odborn\u00edk\u016f. V dob\u011b, kdy bylo rozhodnuto, byl stav nemocn\u00e9 dobr\u00fd a soud rozhodl spr\u00e1vn\u011b. Nemocn\u00e1 nebyla nebezpe\u010dn\u00e1. I pachatel\u00e9 bez psychotick\u00e9 poruchy jsou po v\u00fdkonu trestu propu\u0161t\u011bni. Mus\u00ed tomu tak b\u00fdt, a oni p\u00e1chali trestnou \u010dinnost a byli nebezpe\u010dn\u00ed se stejnou osobnostn\u00ed strukturou a stejnou nebezpe\u010dnost\u00ed, jako kdy\u017e jsou propou\u0161t\u011bni.
\nNaproti tomu pachatel s v\u00e1\u017enou du\u0161evn\u00ed poruchou, kter\u00e1 je p\u0159\u00ed\u010dinou sp\u00e1ch\u00e1n\u00ed trestn\u00e9ho \u010dinu, je mnohem m\u00e9n\u011b nebezpe\u010dn\u00fd, kdy\u017e je propu\u0161t\u011bn, proto\u017ee du\u0161evn\u00ed porucha, kter\u00e1 byla p\u0159\u00ed\u010dinou, je l\u00e9\u010den\u00edm minimalizov\u00e1na. Existuje samoz\u0159ejm\u011b riziko, \u017ee se choroba znovu zhor\u0161\u00ed, a je nutno tomu l\u00e9\u010den\u00edm p\u0159edch\u00e1zet. Tedy riziko je u \u00bbdu\u0161evn\u011b zdrav\u00e9ho\u00ab pachatele mnohem v\u011bt\u0161\u00ed a nikdo nen\u00ed \u0161okov\u00e1n, kdy\u017e je \u00bbzdrav\u00fd\u00ab pachatel n\u00e1siln\u00e9ho trestn\u00e9ho \u010dinu propu\u0161t\u011bn z v\u011bzen\u00ed, ani kdy\u017e zrecidivuje. \u0160ok ve\u0159ejnosti je \u00bbz\u00e1sluha\u00ab m\u00e9di\u00ed.<\/p>\n

– Co je to vlastn\u011b schizofrenie? Jak se projevuje?<\/p>\n

Schizofrenie je velmi v\u00e1\u017en\u00e1 du\u0161evn\u00ed nemoc, kter\u00e1 obvykle za\u010d\u00edn\u00e1 v mlad\u00e9m dosp\u011bl\u00e9m v\u011bku a projevuje se zejm\u00e9na poruchami my\u0161len\u00ed, kdy nemocn\u00ed vlivem choroby vid\u00ed souvislosti tam, kde nejsou, a nakonec uv\u011b\u0159\u00ed v re\u00e1lnost velmi deformovan\u00e9ho obrazu skute\u010dnosti. Nej\u010dast\u011bji se c\u00edt\u00ed b\u00fdt pron\u00e1sledov\u00e1ni. B\u011b\u017en\u00e9 jsou tak\u00e9 poruchy vn\u00edm\u00e1n\u00ed, zejm\u00e9na sluchov\u00e9 halucinace, nemocn\u00ed obvykle sly\u0161\u00ed hlasy, kter\u00e9 je ur\u00e1\u017eej\u00ed, komentuj\u00ed jejich jedn\u00e1n\u00ed, nebo jim d\u00e1vaj\u00ed p\u0159\u00edkazy, kter\u00fdm n\u011bkte\u0159\u00ed nemocn\u00ed vyhov\u00ed. N\u011bkte\u0159\u00ed pod jejich vlivem jednaj\u00ed n\u00e1siln\u011b. Skute\u010dn\u011b nebezpe\u010dn\u00fdch nemocn\u00fdch je ale asi jedno procento. Stav zhor\u0161uje zejm\u00e9na zneu\u017e\u00edv\u00e1n\u00ed n\u00e1vykov\u00fdch l\u00e1tek, v \u010cR hlavn\u011b pervitinu.
\nChoroba je bohu\u017eel dosti \u010dast\u00e1, b\u011bhem \u017eivota onemocn\u00ed asi jedno procento populace. V\u011bt\u0161ina se neobejde bez invalidn\u00edho d\u016fchodu, n\u011bkte\u0159\u00ed pot\u0159ebuj\u00ed trvalou p\u00e9\u010di, bez n\u00ed\u017e kon\u010d\u00ed jako bezdomovci.<\/p>\n

– Je mo\u017en\u00e9 pacienta trp\u00edc\u00edho touto nemoc\u00ed p\u0159ipravit do norm\u00e1ln\u00edho \u017eivota, anebo je odsouzen na st\u00e1l\u00fd pobyt v l\u00e9\u010debn\u00e9m za\u0159\u00edzen\u00ed?<\/p>\n

V\u011bt\u0161ina nemocn\u00fdch je schopna v\u00edce m\u00e9n\u011b samostatn\u011b fungovat ve spole\u010dnosti, kter\u00e1 \u00fapln\u011b neztratila zbytky soudr\u017enosti a solidarity. Z tohoto hlediska se situace v \u010cR st\u00e1le zhor\u0161uje. Stav z\u00e1sadn\u00edm zp\u016fsobem zlep\u0161uje vhodn\u00e9 l\u00e9\u010den\u00ed. N\u011bkte\u0159\u00ed nemocn\u00ed se mu v\u0161ak vyh\u00fdbaj\u00ed.<\/p>\n

– Vra\u0165me se k v\u00fdchoz\u00edmu p\u0159\u00edpadu. V po\u0159adu pan\u00ed J\u00edlkov\u00e9 M\u00e1te slovo jste mluvil o syst\u00e9mov\u00fdch nedostatc\u00edch. Co jste jimi myslel? Jak\u00e1 byste vy navrhoval \u0159e\u0161en\u00ed?<\/p>\n

U\u017e jsem zde zm\u00ednil absenci intenzivn\u011bj\u0161\u00edch forem psychiatrick\u00e9 a soci\u00e1ln\u00ed p\u00e9\u010de. Pomoci p\u0159edej\u00edt podobn\u00fdm ud\u00e1lostem by pomohla tak\u00e9 mo\u017enost nucen\u011b l\u00e9\u010dit nemocn\u00e9, kte\u0159\u00ed vykazuj\u00ed zn\u00e1mky nebezpe\u010dnosti a je\u0161t\u011b nesp\u00e1chali trestn\u00fd \u010din. N\u011bkte\u0159\u00ed nemocn\u00ed terorizuj\u00ed zejm\u00e9na rodinn\u00e9 p\u0159\u00edslu\u0161n\u00edky. Rozhodovat by musel soud.<\/p>\n

– Nejsou sou\u010dasn\u00e9 probl\u00e9my v t\u00e9to zdravotn\u00ed disciplin\u011b vyvol\u00e1ny i sou\u010dasnou spole\u010denskou situac\u00ed?<\/p>\n

P\u00e9\u010de, kter\u00e1 je u n\u00e1s poskytov\u00e1na, je stejn\u011b kvalitn\u00ed jako v nejvysp\u011blej\u0161\u00edch zem\u00edch, ale nen\u00ed komplexn\u00ed, ubytovac\u00ed standard l\u016f\u017ekov\u00fdch za\u0159\u00edzen\u00ed je v\u011bt\u0161inou n\u00edzk\u00fd a \u010d\u00e1st nemocn\u00fdch unik\u00e1 ze syst\u00e9mu p\u00e9\u010de, kter\u00fd jim pak nem\u016f\u017ee pomoci. Pacient si sice \u010d\u00e1ste\u010dn\u011b m\u016f\u017ee vybrat, kde se bude l\u00e9\u010dit, ale mnoz\u00ed se nec\u00edt\u00ed nemocn\u00fdmi a vyberou si, \u017ee se nebudou l\u00e9\u010dit nikde. Je to do zna\u010dn\u00e9 m\u00edry zp\u016fsobeno rozkladem organizace p\u00e9\u010de a chyb\u011bj\u00edc\u00ed odpov\u011bdnosti. Oboj\u00edho bylo dosa\u017eeno \u00famysln\u011b hlavn\u011b na za\u010d\u00e1tku devades\u00e1t\u00fdch let. Vliv m\u00e1 samoz\u0159ejm\u011b i neschopnost rodin pomoci. Ta se prohlubuje u\u017e asi 150 let.<\/p>\n

– Tom\u00e1\u0161 Garrigue Masaryk napsal svou studii \u00bbSebevra\u017eda jako hromadn\u00fd jev spole\u010densk\u00fd\u00ab, v n\u00ed\u017e se zab\u00fdv\u00e1 i soci\u00e1ln\u00edmi podm\u00ednkami, kter\u00e9 k sebevra\u017ed\u011b mohou v\u00e9st. Jak je to se sebevra\u017edami nyn\u00ed?<\/p>\n

Pokud m\u00e1me na mysli stav v \u010cR, tak sebevra\u017eednost v posledn\u00edch dvou desetilet\u00edch klesala, ale v posledn\u00edch letech op\u011bt roste. Nejvy\u0161\u0161\u00ed sebevra\u017eednost v Evrop\u011b je pr\u00e1v\u011b v t\u011bch zem\u00edch, kde chyb\u00ed p\u00e9\u010de o soci\u00e1ln\u011b ohro\u017een\u00e9 a vylou\u010den\u00e9 a rodina d\u00e1vno ztratila svoji roli. Jsou to nap\u0159\u00edklad Loty\u0161sko a Litva. Velk\u00fd v\u00fdznam m\u00e1 tak\u00e9 velk\u00e1 emigrace kv\u016fli bezperspektivnosti a bezperspektivnost kv\u016fli velk\u00e9 emigraci. Sta\u0159\u00ed lid\u00e9 z\u016fst\u00e1vaj\u00ed sami a mlad\u00ed nemaj\u00ed uplatn\u011bn\u00ed. Na Malt\u011b je sebevra\u017eednost jeden\u00e1ctkr\u00e1t ni\u017e\u0161\u00ed\u2026<\/p>\n

– Spisovatelka Joanne Rowlingov\u00e1 kritizovala p\u0159ed \u010dasem \u010deskou psychiatrickou l\u00e9\u010dbu. M\u00e9dia se chytila s\u00ed\u0165ov\u00fdch l\u016f\u017eek. Mysl\u00edte, \u017ee m\u011bla pravdu, anebo zase \u0161lo o jednu z velk\u00fdch bublin sleduj\u00edc\u00edch jist\u00e9 c\u00edle?<\/p>\n

N\u011bkte\u0159\u00ed lid\u00e9 prosazuj\u00ed \u00bblidsk\u00e1 pr\u00e1va\u00ab bez ohledu na to, jak\u00e9 to m\u00e1 d\u016fsledky. N\u011bkte\u0159\u00ed \u010de\u0161t\u00ed experti trvaj\u00ed na odstran\u011bn\u00ed postranic u l\u016f\u017eek, proto\u017ee jsou omezen\u00edm pohybu. Zast\u00e1vaj\u00ed n\u00e1zor, \u017ee zmaten\u00fd dementn\u00ed star\u00fd \u010dlov\u011bk m\u00e1 pr\u00e1vo spadnout z postele a zlomit si kr\u010dek kosti stehenn\u00ed. Zn\u00ed to neuv\u011b\u0159iteln\u011b, ale je to tak. Pan\u00ed Rowlingov\u00e1 je velmi popul\u00e1rn\u00ed a velmi bohat\u00e1. To ji z\u0159ejm\u011b vede k p\u0159esv\u011bd\u010den\u00ed, \u017ee nepot\u0159ebuje \u017e\u00e1dn\u00e9 znalosti a zku\u0161enosti k tomu, aby se mohla spr\u00e1vn\u011b rozhodnout. Podobnou poruchu lze pozorovat i u n\u011bkter\u00fdch funkcion\u00e1\u0159\u016f.<\/p>\n

– V\u00edm, \u017ee hled\u00e1te jist\u00e1 \u0159e\u0161en\u00ed situace, kter\u00e1 vede a\u017e k v\u00e1m psychiatr\u016fm. Jak\u00e9 tedy vy nab\u00edz\u00edte \u0159e\u0161en\u00ed?<\/p>\n

Odborn\u00edci v\u011bd\u00ed, jak postupovat p\u0159i \u0159e\u0161en\u00ed odborn\u00fdch ot\u00e1zek. Maj\u00ed k tomu vzd\u011bl\u00e1n\u00ed i zku\u0161enosti. Doporu\u010duji nedat na rady \u00bbexpert\u016f\u00ab na \u00bblidsk\u00e1 pr\u00e1va\u00ab, \u00bbpravdu a l\u00e1sku\u00ab a podobn\u00e9 obory. \u0158e\u0161en\u00ed objeven\u00e1 \u00bbexperty\u00ab, kte\u0159\u00ed znalosti a zku\u0161enosti postr\u00e1daj\u00ed, nemohou b\u00fdt dobr\u00e1. Pr\u00e1v\u011b takov\u00ed lid\u00e9 z\u00edsk\u00e1vaj\u00ed st\u00e1le v\u00edce rozhodovac\u00edch pravomoc\u00ed. Pokud se to nezm\u011bn\u00ed, \u010dek\u00e1 n\u00e1s mimo\u0159\u00e1dn\u011b \u00bb\u0161\u0165astn\u00e1\u00ab budoucnost…<\/p>\n

Jaroslav KOJZAR Hal\u00f3 noviny<\/p>\n","protected":false},"excerpt":{"rendered":"

Rozhovor s psychiatrem MUDr. Ivanem Davidem, b\u00fdval\u00fdm ministrem zdravotnictv\u00ed. O schizofrenii, legislativ\u011b a \u00fastavn\u00ed i n\u00e1sledn\u00e9 p\u00e9\u010di.<\/p>\n<\/div>","protected":false},"author":1,"featured_media":17947,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[12],"tags":[],"class_list":["post-18672","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-rozhovory"],"_links":{"self":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/18672","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=18672"}],"version-history":[{"count":0,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/18672\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/media\/17947"}],"wp:attachment":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=18672"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=18672"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=18672"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}