{"id":24346,"date":"2016-02-06T11:01:37","date_gmt":"2016-02-06T10:01:37","guid":{"rendered":"http:\/\/www.invarena.cz\/?p=24346"},"modified":"2016-02-06T11:01:37","modified_gmt":"2016-02-06T10:01:37","slug":"halucinace","status":"publish","type":"post","link":"https:\/\/www.invarena.cz\/?p=24346","title":{"rendered":"Halucinace…."},"content":{"rendered":"

Milanovi je 21 let, studuje vysokou \u0161kolu, je svobodn\u00fd a bydl\u00ed s rodi\u010di. Sna\u017e\u00ed se u\u010dit ke zkou\u0161ce, ale nejde mu to. Nem\u016f\u017ee se soust\u0159edit. Chv\u00edlemi nev\u00ed, co se to s n\u00edm d\u011bje, proto\u017ee m\u00e1 dojem, \u017ee na n\u011bho n\u011bkdo mluv\u00ed. V byt\u011b je s\u00e1m a v tom vedlej\u0161\u00edm bydl\u00ed jedna star\u00e1 vdova, ale hlas, kter\u00fd k n\u011bmu promlouv\u00e1, je mu\u017esk\u00fd. Chv\u00edli je ticho a najednou mu ten mu\u017e \u0159ekne: „Neu\u010d se a jdi ven, stejn\u011b se to nikdy nenau\u010d\u00ed\u0161, jsi nula a nulou z\u016fstane\u0161.“<\/strong><\/p>\n

Milan p\u00e1tr\u00e1 v pam\u011bti, komu ze zn\u00e1m\u00fdch by ten hlas mohl pat\u0159it, a po chv\u00edli usoud\u00ed, \u017ee asi spolu\u017e\u00e1kovi Luk\u00e1\u0161ovi ze st\u0159edn\u00ed \u0161koly. M\u00edvali spolu debaty o \u017eivot\u011b a Luk\u00e1\u0161 byl v\u017edycky o kus nap\u0159ed, ch\u00e1pal v\u011bci jinak ne\u017e Milan, vid\u011bl souvislosti a \u010dasto Milana pou\u010doval. A te\u010f tohle? \u017de by Luk\u00e1\u0161 v\u011bd\u011bl, jak t\u011b\u017eko se Milan u\u010d\u00ed? A zase to sly\u0161\u00ed: „Nech toho u\u010den\u00ed a jdi ven, stejn\u011b se to nenau\u010d\u00ed\u0161.“ A tak Milan vypne po\u010d\u00edta\u010d a jde ven…<\/p>\n

J\u00e1 m\u00e1m pravdu!<\/p>\n

Mohlo by se zd\u00e1t, \u017ee o tak zn\u00e1m\u00e9 psychick\u00e9 poru\u0161e, jako jsou halucinace, bylo ji\u017e \u0159e\u010deno a naps\u00e1no tolik, \u017ee nen\u00ed t\u0159eba se t\u00edmto t\u00e9matem zab\u00fdvat. Nicm\u00e9n\u011b pr\u00e1v\u011b proto, \u017ee je to porucha tak \u010dast\u00e1 a z\u00e1va\u017en\u00e1, mysl\u00edm, \u017ee nen\u00ed na \u0161kodu ur\u010dit\u00e9 poznatky o n\u00ed p\u0159ipomenout a shrnout z pohledu zku\u0161enost\u00ed dlouholet\u00e9ho psychiatra z praxe.
\nV psychiatrick\u00fdch u\u010debnic\u00edch se p\u0159edev\u0161\u00edm p\u00ed\u0161e, \u017ee halucinace jsou poruchou vn\u00edm\u00e1n\u00ed. \u010clov\u011bk vn\u00edm\u00e1 n\u011bco, co neexistuje. To je sice pravda, ale jak si to m\u00e1 zdrav\u00fd \u010dlov\u011bk p\u0159edstavit? Vn\u00edm\u00e1n\u00ed se t\u00fdk\u00e1 na\u0161ich smysl\u016f, a proto halucinace rozd\u011blujeme na sluchov\u00e9 (auditivn\u00ed), zrakov\u00e9 (vizu\u00e1ln\u00ed), \u010dichov\u00e9 (olfaktorick\u00e9), chu\u0165ov\u00e9 (gustatorick\u00e9), hmatov\u00e9 (taktiln\u00ed) a d\u00e1le t\u011blov\u00e9 a org\u00e1nov\u00e9 (somatick\u00e9 a viscer\u00e1ln\u00ed). Pro\u010d \u010dlov\u011bk sly\u0161\u00ed, vid\u00ed, \u010dich\u00e1, chutn\u00e1, hmat\u00e1 a bolestiv\u011b c\u00edt\u00ed n\u011bco, co neexistuje, se zat\u00edm nepoda\u0159ilo zjistit. P\u0159\u00ed\u010dina se hled\u00e1 zejm\u00e9na v biologick\u00e9 podstat\u011b, v receptorech a r\u016fzn\u00fdch biochemick\u00fdch medi\u00e1torech, ale tyto hypot\u00e9zy nejsou s to objasnit problematiku v jej\u00edm celku. Zaj\u00edmav\u00e9 je, \u017ee posti\u017een\u00fd \u010dlov\u011bk je tak nev\u00fdvratn\u011b p\u0159esv\u011bd\u010den o pravosti sv\u00fdch vjem\u016f, \u017ee jim v\u011b\u0159\u00ed v\u00edce ne\u017e skute\u010dn\u00fdm pro\u017eitk\u016fm a tak\u00e9 v\u00edce ne\u017e logick\u00e9mu vysv\u011btlen\u00ed sv\u00e9ho rozumu. Nemocn\u00fd v\u00ed, \u017ee je nap\u0159. v pokoji s\u00e1m, \u017ee zdi od soused\u016f jsou siln\u00e9 a nem\u016f\u017ee b\u00fdt od nich nic sly\u0161et, ale on to sly\u0161\u00ed a je sk\u00e1lopevn\u011b p\u0159esv\u011bd\u010den, \u017ee je to pravda. Teprve po l\u00e9\u010db\u011b, a\u017e halucinace odezn\u00ed, je pacient ochoten p\u0159ipustit, \u017ee jeho vjemy byly projevem choroby, \u017ee to pravda nebyla. A pokud se stav b\u011bhem let \u010dasto opakuje nebo halucinace p\u0159ejdou do chronick\u00e9ho stavu, kdy jako jist\u00e9 reziduum p\u0159etrv\u00e1vaj\u00ed t\u0159eba i n\u011bkolik let, pacient se s nimi nau\u010d\u00ed \u017e\u00edt a u\u017e v\u00ed, \u017ee se nem\u00e1 znepokojovat a \u017ee je to, bohu\u017eel, jak\u00e1si nezbytn\u00e1 sou\u010d\u00e1st jeho \u017eivota, jak\u00e9si b\u0159emeno, s n\u00edm\u017e se mus\u00ed sm\u00ed\u0159it.<\/p>\n

Hlasy v hlav\u011b<\/p>\n

Nej\u010dast\u011bj\u0161\u00ed jsou halucinace sluchov\u00e9. Pacienti jim b\u011b\u017en\u011b \u0159\u00edkaj\u00ed „hlasy“. V\u011bt\u0161inou je sly\u0161\u00ed u\u0161ima, ale existuj\u00ed i p\u0159\u00edpady, \u017ee pacient „hlasy“ vn\u00edm\u00e1 jin\u00fdm org\u00e1nem, nosem, zuby, cel\u00fdm t\u011blem. N\u011bkdy jsou „hlasy“ skute\u010dn\u011b hlasit\u00e9 a maj\u00ed podobu mu\u017esk\u00e9ho nebo \u017eensk\u00e9ho hlasu, jindy jsou jen nev\u00fdrazn\u00e9, bezbarv\u00e9, tak\u017ee pacient nev\u00ed, jestli to mluv\u00ed mu\u017e nebo \u017eena. A n\u011bkdy vn\u00edm\u00e1 \u0159e\u010d jakoby uvnit\u0159 hlavy, nesly\u0161\u00ed je u\u0161ima, ale sp\u00ed\u0161e mu p\u0159ipadaj\u00ed jako my\u0161lenky, kter\u00e9 n\u011bkdy pova\u017euje za svoje vlastn\u00ed, jindy za ciz\u00ed (halucinace intrakrani\u00e1ln\u00ed). „Hlasy“ mohou mluvit p\u0159\u00edmo k pacientovi, n\u011bco mu p\u0159ikazovat, radit mu, kritizovat ho (z\u0159\u00eddka ho chv\u00e1l\u00ed), jindy „hlasy“ hovo\u0159\u00ed mezi sebou, h\u00e1daj\u00ed se, komentuj\u00ed pacientovo jedn\u00e1n\u00ed. „Hlasy“ p\u0159ikazuj\u00edc\u00ed (imperativn\u00ed) mohou b\u00fdt velmi nebezpe\u010dn\u00e9, proto\u017ee nemocn\u00fd pod jejich vlivem m\u016f\u017ee ud\u011blat n\u011bco, co by ve zdrav\u00e9m stavu nikdy neud\u011blal, nap\u0159. n\u011bkomu ubl\u00ed\u017eit, n\u011bco ukr\u00e1st, rozb\u00edt, sp\u00e1chat sebevra\u017edu.
\nRelativn\u011b \u010dast\u00e9 jsou tak\u00e9 halucinace zrakov\u00e9. Pacient m\u016f\u017ee vid\u011bt r\u016fzn\u00e9 lidi nebo zv\u00ed\u0159ata, kter\u00e1 v\u0161ak v dan\u00e9m m\u00edst\u011b nejsou. S oblibou se hovo\u0159\u00ed o halucinaci b\u00edl\u00fdch my\u0161ek p\u0159i deliriu tremens, ale to je sp\u00ed\u0161e jen jak\u00e1si liter\u00e1rn\u00ed a lidov\u00e1 tradice ne\u017e realita. Nicm\u00e9n\u011b zrakov\u00e9 halucinace v deliriu tremens i v jin\u00fdch deliri\u00edch jsou z\u00e1kladn\u00ed sou\u010d\u00e1st\u00ed psychopatologick\u00e9ho obrazu, ov\u0161em pacient m\u016f\u017ee vid\u011bt velmi r\u016fzn\u00e9 v\u011bci, lidi, zv\u00ed\u0159ata, obrazce.
\nM\u00e9n\u011b \u010dasto se setk\u00e1v\u00e1me s dal\u0161\u00edmi t\u0159emi typy halucinac\u00ed, a sice s halucinacemi \u010dichov\u00fdmi, chu\u0165ov\u00fdmi a hmatov\u00fdmi. \u010cichov\u00e9 a chu\u0165ov\u00e9 halucinace b\u00fdvaj\u00ed n\u011bkdy pro\u017e\u00edv\u00e1ny sou\u010dasn\u011b, zejm\u00e9na jde-li o kvalitu j\u00eddla, kter\u00e9 pacientovi m\u016f\u017ee p\u0159ipadat \u0161patn\u00e9, zejm\u00e9na pokud je p\u0159esv\u011bd\u010den, \u017ee je otr\u00e1ven\u00e9 n\u011bjak\u00fdm jedem, proto\u017ee ho kdosi chce usmrtit. \u010cichov\u00e9 halucinace se mohou samostatn\u011b vyskytovat jako r\u016fzn\u00e9 z\u00e1pachy rovn\u011b\u017e spojen\u00e9 s interpretac\u00ed otravy. S halucinacemi hmatov\u00fdmi se pak m\u016f\u017eeme setkat u n\u011bkter\u00fdch psych\u00f3z, kdy pacient c\u00edt\u00ed, jak mu leze hmyz po jeho t\u011ble, poci\u0165uje r\u016fzn\u00e1 mraven\u010den\u00ed, p\u00e1len\u00ed, \u0161t\u00edp\u00e1n\u00ed apod.<\/p>\n

Org\u00e1nov\u00e9 halucinace<\/p>\n

Org\u00e1nov\u00e9 halucinace se naopak vyskytuj\u00ed dosti \u010dasto v podob\u011b r\u016fzn\u00fdch bolest\u00ed a jin\u00fdch nep\u0159\u00edjemn\u00fdch pocit\u016f na nejr\u016fzn\u011bj\u0161\u00edch m\u00edstech t\u011bla. Pacient je vn\u00edm\u00e1 obvykle velmi intenzivn\u011b a nech\u00e1v\u00e1 se \u010dasto opakovan\u011b t\u011blesn\u011b vy\u0161et\u0159ovat. Somatick\u00e9 n\u00e1lezy v\u0161ak nikdy neprok\u00e1\u017eou t\u011blesnou nemoc, \u010demu\u017e ov\u0161em pacient nev\u011b\u0159\u00ed a do\u017eaduje se dal\u0161\u00edch a dal\u0161\u00edch vy\u0161et\u0159en\u00ed. Praktick\u00fd l\u00e9ka\u0159, internista nebo chirurg je \u010dasto bezradn\u00fd a ve snaze pacientovi pomoci ordinuje nov\u00e1 a nov\u00e1 vy\u0161et\u0159en\u00ed, kter\u00e1 jsou v\u0161ak op\u011bt negativn\u00ed. Nejsou vz\u00e1cnost\u00ed ani operativn\u00ed z\u00e1kroky, kter\u00e9 rovn\u011b\u017e pacientovy pot\u00ed\u017ee nevysv\u011btl\u00ed, co\u017e teprve vede k tomu, \u017ee je pacient posl\u00e1n na psychiatrii.
\nPacienti s t\u011bmito p\u0159\u00edznaky se v\u0161ak velmi \u010dasto psychiatrick\u00e9mu vy\u0161et\u0159en\u00ed br\u00e1n\u00ed a z podstaty sv\u00e9 choroby nejsou schopni pochopit, \u017ee jejich t\u011blesn\u00e9 bolesti maj\u00ed psychick\u00fd, resp. psychotick\u00fd p\u016fvod. Z jejich pohledu jsou jejich pot\u00ed\u017ee skute\u010dn\u00e9 a nepova\u017euj\u00ed se za n\u011bjak\u00e9 „bl\u00e1zny“, aby si to vym\u00fd\u0161leli. Zde je t\u0159eba poznamenat, \u017ee pacienti si sv\u00e9 pot\u00ed\u017ee opravdu nevym\u00fd\u0161lej\u00ed, jejich bolesti jsou realitou, nicm\u00e9n\u011b etiopatogeneze t\u00e9to reality nen\u00ed somatick\u00e1, ale psychotick\u00e1.
\nNa tomto m\u00edst\u011b bych r\u00e1da upozornila, \u017ee je nutno odli\u0161ovat tyto bolestiv\u00e9 halucinace od bolestiv\u00fdch pocit\u016f pacient\u016f s r\u016fzn\u00fdmi formami neur\u00f3z, ale to ji\u017e pat\u0159\u00ed do rukou psychiatr\u016f, aby se v tom vyznali. Pro psychology, kou\u010de i laiky plat\u00ed pouze to, \u017ee je t\u0159eba na t\u011blov\u00e9 halucinace myslet a nepova\u017eovat ka\u017edou popisovanou bolest za neurotickou, kterou lze l\u00e9\u010dit psychoterapeuticky, a nezapom\u00ednat na to, \u017ee m\u016f\u017ee j\u00edt o stav psychotick\u00fd, \u010dili rizikov\u00fd z hlediska dal\u0161\u00edho v\u00fdvoje v\u010detn\u011b mo\u017enosti sebevra\u017edy.<\/p>\n

P\u0159\u00edznak n\u011bkolika diagn\u00f3z<\/p>\n

Halucinace jsou jedn\u00edm z nej\u010dast\u011bj\u0161\u00edch psychiatrick\u00fdch p\u0159\u00edznak\u016f. Mohou b\u00fdt sou\u010d\u00e1st\u00ed psychopatologick\u00e9ho obrazu jak\u00e9koli psych\u00f3zy, zejm\u00e9na schizofrenie, t\u011b\u017ek\u00fdch depres\u00ed, psych\u00f3z u demenc\u00ed i psych\u00f3z u z\u00e1vislost\u00ed na alkoholu a drog\u00e1ch (kam pat\u0159\u00ed i alkoholick\u00e9 delirium tremens). Diagnostick\u00e9 stanoven\u00ed halucinace nen\u00ed v\u017edy tak snadn\u00e9, jak se m\u016f\u017ee zd\u00e1t, a pat\u0159\u00ed v\u017edy do rukou psychiatra.
\nJe t\u0159eba s pacientem podrobn\u011b hovo\u0159it a nejednou je nutno jeho sd\u011blen\u00ed objektivizovat je\u0161t\u011b pohovorem s rodinn\u00fdmi p\u0159\u00edslu\u0161n\u00edky nebo jin\u00fdmi mi lidmi z jeho okol\u00ed. Zejm\u00e9na p\u0159i podez\u0159en\u00ed na halucinace t\u011blov\u00e9 a viscer\u00e1ln\u00ed je v\u017edy nutno nejprve pacienta d\u016fkladn\u011b vy\u0161et\u0159it somaticky, abychom vylou\u010dili mo\u017en\u00e9 org\u00e1nov\u00e9 onemocn\u011bn\u00ed, nicm\u00e9n\u011b charakter t\u011bchto halucinac\u00ed ji\u017e s\u00e1m napov\u00edd\u00e1 o jejich psychotick\u00e9m p\u016fvodu.
\nTerapie nespo\u010d\u00edv\u00e1 v odstra\u0148ov\u00e1n\u00ed jednotliv\u00fdch halucinac\u00ed, jak si to n\u011bkdy p\u0159edstavuj\u00ed laici. Nel\u00e9\u010d\u00edme halucinace, l\u00e9\u010d\u00edme cel\u00fd psychotick\u00fd stav pacienta, proto\u017ee halucinace se nikdy nevyskytnou samy o sob\u011b, ale v\u017edy a jedin\u011b v r\u00e1mci n\u011bjak\u00e9 psych\u00f3zy, co\u017e je v\u00e1\u017en\u00e1 porucha cel\u00e9 osobnosti. Je tedy t\u0159eba l\u00e9\u010dit tuto psych\u00f3zu, a to v\u017edy pomoc\u00ed psychofarmak. Doprovodn\u00e1 psychoterapie je p\u0159\u00edsn\u011b individu\u00e1ln\u00ed a z\u00e1le\u017e\u00ed na tom, o jakou diagn\u00f3zu jde a jak pacient spolupracuje. Plat\u00ed ov\u0161em z\u00e1sada, \u017ee halucinace pacientovi nikdy nevymlouv\u00e1me a nep\u0159esv\u011bd\u010dujeme ho o tom, \u017ee n\u011bco takov\u00e9ho nen\u00ed mo\u017en\u00e9. V\u017edy mu pe\u010dliv\u011b naslouch\u00e1me a sna\u017e\u00edme se, aby k n\u00e1m neztratil d\u016fv\u011bru a aby spolupracoval zejm\u00e9na v tom, \u017ee bude u\u017e\u00edvat l\u00e9ky. Samotn\u00e1 psychoterapie psych\u00f3zu s halucinacemi nezvl\u00e1dne.
\nVra\u0165me se nyn\u00ed k p\u0159\u00edpadu studenta Milana. Co m\u016f\u017ee napov\u011bd\u011bt? Jeho sluchov\u00e9 halucinace byly mo\u017en\u00e1 provokov\u00e1ny studijn\u00ed z\u00e1t\u011b\u017e\u00ed, kterou dostate\u010dn\u011b nezvl\u00e1d\u00e1. Halucinace jsou jednak kritizuj\u00edc\u00ed, jednak imperativn\u00ed. Pod jejich vlivem pacient jedn\u00e1, tedy na jejich p\u0159\u00edkaz skute\u010dn\u011b zav\u00edr\u00e1 u\u010debn\u00ed program a jde ven. Mohli bychom si d\u00e1le domyslet, \u017ee by teoreticky halucinace mohly „hovo\u0159it“ k pacientovi d\u00e1l a mohly by ho je\u0161t\u011b v\u00edce kritizovat za jeho domn\u011blou neschopnost. Nelze vylou\u010dit ani ten nejhor\u0161\u00ed v\u00fdvoj sm\u011brem k sebevra\u017eedn\u00e9mu jedn\u00e1n\u00ed pod vlivem t\u00e9to kritiky nebo i p\u0159\u00edm\u00e9ho halucinatorn\u00edho p\u0159\u00edkazu. Opakuji proto, \u017ee jak\u00fdkoli podobn\u00fd stav je v\u00e1\u017en\u00fdm psychiatrick\u00fdm p\u0159\u00edznakem, nelze ho podce\u0148ovat a v\u017edy je t\u0159eba vy\u0161et\u0159en\u00ed psychiatra, kter\u00fd rozhodne o dal\u0161\u00edm postupu a l\u00e9\u010db\u011b pacienta.<\/p>\n

Pou\u017eit\u00ed textu bez citace je trestn\u00e9. Dal\u0161\u00ed podrobnosti o t\u00e9to problematice najdete v knize Helena Ku\u010derov\u00e1: Psychiatrick\u00e9 minimum, 2013, Grada Publishing, Praha.<\/p>\n

—<\/p>\n

Terapie nespo\u010d\u00edv\u00e1 v odstra\u0148ov\u00e1n\u00ed jednotliv\u00fdch halucinac\u00ed, jak si to n\u011bkdy p\u0159edstavuj\u00ed laici.<\/p>\n

O autorovi: Helena Ku\u010derov\u00e1, Autorka m\u00e1 psychiatrickou ordinaci v Hranic\u00edch na Morav\u011b.<\/p>\n

Helena Ku\u010derov\u00e1
\nPsychologie dnes<\/p>\n","protected":false},"excerpt":{"rendered":"

Milanovi je 21 let, studuje vysokou \u0161kolu, je svobodn\u00fd a bydl\u00ed s rodi\u010di. Sna\u017e\u00ed se u\u010dit ke zkou\u0161ce, ale nejde mu to. Nem\u016f\u017ee se soust\u0159edit. […]<\/a><\/p>\n<\/div>","protected":false},"author":1,"featured_media":13918,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[9],"tags":[],"class_list":["post-24346","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-zpravy"],"_links":{"self":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/24346","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=24346"}],"version-history":[{"count":0,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/24346\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/media\/13918"}],"wp:attachment":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=24346"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=24346"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=24346"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}