Jist\u011b to zn\u00e1te. M\u00e1te nemocn\u00e9ho p\u0159\u00edbuzn\u00e9ho, ale ten tvrd\u00ed, \u017ee mu nic nen\u00ed, a k doktorovi ho prost\u011b nem\u016f\u017eete dostat. Zvl\u00e1\u0161t\u011b mu\u017ei to berou n\u011bkdy skoro jako osobn\u00ed prohru. V p\u0159\u00edpad\u011b psychick\u00e9ho onemocn\u011bn\u00ed je to je\u0161t\u011b mnohem \u010dast\u011bj\u0161\u00ed. A m\u016f\u017ee j\u00edt p\u0159itom o lidi v\u00e1\u017en\u011b psychicky nemocn\u00e9. Jen\u017ee p\u0159iznat si, \u017ee jsem du\u0161evn\u011b nemocn\u00fd, \u017ee pojedu „do bl\u00e1zince“, to je pro \u0159adu z n\u00e1s obt\u00ed\u017en\u00e9.<\/p>\n
Nejde p\u0159itom o \u017e\u00e1dnou legraci. Mohou to b\u00fdt lid\u00e9 nemocn\u00ed schizofreni\u00ed, velkou depres\u00ed, demenc\u00ed, osoby holduj\u00edc\u00ed alkoholu, na n\u011bm\u017e jsou obvykle ji\u017e z\u00e1visl\u00ed, i lid\u00e9 u\u017e\u00edvaj\u00edc\u00ed drogy. Jak v takov\u00e9m p\u0159\u00edpad\u011b postupovat?<\/p>\n
Nic mi p\u0159ece nen\u00ed!<\/p>\n
U schizofrenick\u00fdch pacient\u016f se st\u00e1v\u00e1, \u017ee pacient natolik v\u011b\u0159\u00ed sv\u00fdm halucinac\u00edm nebo blud\u016fm, \u017ee je pova\u017euje za normu. Tak\u017ee se celkem logicky nedomn\u00edv\u00e1, \u017ee by bylo t\u0159eba n\u011bjak\u00e9ho l\u00e9ka\u0159sk\u00e9ho z\u00e1sahu. Pacienti s paranoidn\u00edmi p\u0159\u00edznaky zase sv\u00e9 pot\u00ed\u017ee projikuj\u00ed navenek a jejich p\u0159\u00ed\u010dinu vid\u00ed v jin\u00fdch lidech. Naopak pacienti s velkou depres\u00ed odm\u00edtaj\u00ed l\u00e9\u010dbu z p\u0159esn\u011b opa\u010dn\u00fdch d\u016fvod\u016f – mysl\u00ed si, \u017ee p\u0159\u00ed\u010dinou jejich pot\u00ed\u017e\u00ed jsou oni sami, a \u017ee je tedy jejich povinnost\u00ed dostat se z t\u00e9to situace vlastn\u00edmi silami. Jindy b\u00fdv\u00e1 d\u016fvodem odm\u00edt\u00e1n\u00ed l\u00e9\u010dby neochota u\u017e\u00edvat l\u00e9ky, zejm\u00e9na kdy\u017e maj\u00ed ne\u017e\u00e1douc\u00ed vedlej\u0161\u00ed \u00fa\u010dinky. N\u011bkte\u0159\u00ed pacienti se tak\u00e9 ob\u00e1vaj\u00ed hospitalizace, tedy onoho „odvozu do bl\u00e1zince“, kter\u00fd zejm\u00e9na v minul\u00fdch desetilet\u00edch byl mnohdy \u010dast\u011bj\u0161\u00ed, ne\u017e bylo pot\u0159eba. A zase jindy m\u016f\u017ee u\u017e b\u00fdt nemocn\u00fd rozhodnut\u00fd sp\u00e1chat sebevra\u017edu, proto\u017ee nevid\u00ed \u017e\u00e1dn\u00e9 v\u00fdchodisko ze sv\u00e9 situace, a proto l\u00e9\u010dbu pova\u017euje za zbyte\u010dnou. Deprese m\u016f\u017ee b\u00fdt n\u011bkdy tak hlubok\u00e1, \u017ee pacient nem\u00e1 ani s\u00edlu cokoli se sebou podniknout, je zcela vy\u010derpan\u00fd a apatick\u00fd. L\u00e9\u010dbu tedy p\u0159\u00edmo neodm\u00edt\u00e1, ale nen\u00ed schopen ji vyhledat. Do skupiny odm\u00edtav\u00fdch pacient\u016f pat\u0159\u00ed tak\u00e9 nemocn\u00ed s hypochondrick\u00fdmi bludy, v jejich\u017e depresivn\u00edm obraze p\u0159eva\u017euj\u00ed nebo zcela dominuj\u00ed somatick\u00e9 pot\u00ed\u017ee, tak\u017ee pacient nen\u00ed schopen pochopit, pro\u010d by se m\u011bl l\u00e9\u010dit u psychiatra. Pacient je nap\u0159. bludn\u011b p\u0159esv\u011bd\u010den, \u017ee m\u00e1 rakovinu, do\u017eaduje se dal\u0161\u00edch a dal\u0161\u00edch t\u011blesn\u00fdch vy\u0161et\u0159en\u00ed a p\u0159\u00edslu\u0161n\u00e9 terapie a c\u00edt\u00ed se pon\u00ed\u017een a ura\u017een, kdy\u017e ho l\u00e9ka\u0159 pos\u00edl\u00e1 na psychiatrii.
\nLid\u00e9 posti\u017een\u00ed demenc\u00ed se ke sv\u00fdm pot\u00ed\u017e\u00edm, zejm\u00e9na s pam\u011bt\u00ed, stav\u011bj\u00ed r\u016fzn\u011b. N\u011bkte\u0159\u00ed si je pln\u011b uv\u011bdomuj\u00ed a sami vyhledaj\u00ed l\u00e9ka\u0159e. Jin\u00ed naopak naprosto odm\u00edtaj\u00ed uznat jak\u00fdkoli p\u0159\u00edznak sv\u00e9 poruchy a l\u00e9\u010dbu tvrd\u011b odm\u00edtaj\u00ed. Mezi prvn\u00ed pat\u0159\u00ed \u010dasto pacienti s demenc\u00ed Alzheimerova typu, mezi druh\u00e9 pacienti s demenc\u00ed vaskul\u00e1rn\u00edho typu. Ale nen\u00ed to pravidlem. Nav\u00edc se mnohdy oba typy demenc\u00ed prol\u00ednaj\u00ed, tak\u017ee n\u00e1hled chorobnosti nen\u00ed diagnostick\u00fdm krit\u00e9riem. Setk\u00e1v\u00e1me se tak s pacienty, kte\u0159\u00ed ji\u017e p\u0159i po\u010d\u00ednaj\u00edc\u00edch poruch\u00e1ch pam\u011bti, nap\u0159. kdy\u017e si nevzpom\u00ednaj\u00ed na jm\u00e9na sv\u00fdch zn\u00e1m\u00fdch, p\u0159ijdou na vy\u0161et\u0159en\u00ed k psychiatrovi a v\u016fbec to nepova\u017euj\u00ed za n\u011bjak\u00e9 stigma, a na druh\u00e9 stran\u011b s pacienty, kte\u0159\u00ed p\u0159ijdou k psychiatrovi, a\u017e u\u017e si nepamatuj\u00ed t\u00e9m\u011b\u0159 nic, a st\u00e1le p\u0159itom tvrd\u00ed, \u017ee jsou zdr\u00e1vi a \u017ee si doma stihnou okolo sebe v\u0161echno ud\u011blat. Tyto dva extr\u00e9my jsou n\u011bkdy opravdu z\u0159eteln\u00e9, ale jejich p\u0159\u00ed\u010dinu zat\u00edm nedovedeme spolehliv\u011b vysv\u011btlit.
\nV neposledn\u00ed \u0159ad\u011b odm\u00edtaj\u00ed psychiatrickou l\u00e9\u010dbu lid\u00e9 nadm\u011brn\u011b pij\u00edc\u00ed alkohol a u\u017e\u00edvaj\u00edc\u00ed drogy. Asi nikoho nep\u0159ekvap\u00ed, \u017ee s t\u011bmi b\u00fdvaj\u00ed pot\u00ed\u017ee nejv\u011bt\u0161\u00ed. Z\u00e1vislost se u n\u00e1vykov\u00fdch l\u00e1tek v\u0161eho druhu, tedy alkoholu, drog i n\u011bkter\u00fdch medikament\u016f, vyv\u00edj\u00ed pl\u00ed\u017eiv\u011b a nepozorovan\u011b. Tak\u017ee najednou m\u00e1me p\u0159ed sebou jedince ji\u017e z\u00e1visl\u00e9ho, kter\u00fd to ov\u0161em o sob\u011b nev\u00ed a v\u011bd\u011bt nechce, c\u00edt\u00ed se zcela zdr\u00e1v a p\u0159\u00edpadn\u00e9 pot\u00ed\u017ee spojen\u00e9 se svoj\u00ed z\u00e1vislost\u00ed vysv\u011btluje r\u016fzn\u00fdmi vn\u011bj\u0161\u00edmi okolnostmi nebo chybami druh\u00fdch. P\u0159im\u011bt takov\u00e9ho jedince k l\u00e9\u010db\u011b b\u00fdv\u00e1 opravdu probl\u00e9m.<\/p>\n
T\u011b\u017ek\u00fd \u017eivot psychiatra<\/p>\n
\u0160k\u00e1la poruch, kter\u00e9 mohou zp\u016fsobovat \u0161patnou spolupr\u00e1ci pacienta p\u0159i l\u00e9\u010db\u011b, je natolik \u0161irok\u00e1, \u017ee nen\u00ed mo\u017en\u00e9 postupovat podle n\u011bjak\u00e9ho p\u0159edem dan\u00e9ho pravidla. Pokud je pacient v psychotick\u00e9m stavu, a\u0165 u\u017e se jedn\u00e1 o schizofrenii, nebo depresi, a je tu akutn\u00ed nebezpe\u010d\u00ed, \u017ee by mohl sob\u011b nebo n\u011bkomu jin\u00e9mu ubl\u00ed\u017eit, pak je nutno jej hospitalizovat. A to, i kdy\u017e s t\u00edm nesouhlas\u00ed. Psychiatr se ov\u0161em v tomto p\u0159\u00edpad\u011b vystavuje riziku, \u017ee po propu\u0161t\u011bn\u00ed z nemocnice na n\u011bj pacient zanev\u0159e, nebo se mu dokonce bude mst\u00edt. Pacient sice b\u00fdv\u00e1 po odchodu z nemocnice v lep\u0161\u00edm stavu, ale nemus\u00ed z\u00edskat plnou kriti\u010dnost. Svoji nelibost tak projikuje do l\u00e9ka\u0159e, kter\u00fd hospitalizaci doporu\u010dil. A tak se nejednou stane, \u017ee pacient zm\u011bn\u00ed l\u00e9ka\u0159e nebo – v hor\u0161\u00edm p\u0159\u00edpad\u011b – l\u00e9ka\u0159i zp\u016fsobuje nep\u0159\u00edjemnosti v podob\u011b nap\u0159. rozbit\u00e9ho okna v ordinaci, pohozen\u00ed st\u0159ep\u016f okolo l\u00e9ka\u0159ova auta, po\u0161kozen\u00ed z\u00e1mku v po\u0161tovn\u00ed schr\u00e1nce atd. V\u00fdjimkou nejsou ani fyzick\u00e9 \u00fatoky na l\u00e9ka\u0159e. Psychiatrie opravdu nen\u00ed \u017e\u00e1dn\u00fd med\u2026
\nPr\u00e1ce s dementn\u00edmi pacienty, kte\u0159\u00ed odm\u00edtaj\u00ed terapii, b\u00fdv\u00e1 snaz\u0161\u00ed z toho d\u016fvodu, \u017ee takov\u00e9ho pacienta do ordinace obvykle p\u0159ivede rodina. Tito pacienti v\u011bt\u0161inou hospitalizaci nepot\u0159ebuj\u00ed, tak\u017ee l\u00e9ka\u0159 naordinuje l\u00e9ky po domluv\u011b s p\u0159\u00edbuzn\u00fdmi a ti je pak nemocn\u00e9mu pod\u00e1vaj\u00ed. Pacient toti\u017e b\u00fdv\u00e1 ji\u017e natolik dementn\u00ed, \u017ee by si l\u00e9ky s\u00e1m br\u00e1t nemohl, proto\u017ee by je spletl. P\u00e9\u010de rodiny je tedy nezbytn\u00e1.
\nPacienti se z\u00e1vislost\u00ed na alkoholu nebo drog\u00e1ch n\u011bkdy p\u0159ijdou do ordinace na „vlastn\u00ed \u017e\u00e1dost“, proto\u017ee jsou k tomu donuceni sv\u00fdm okol\u00edm, ale v nitru se proti tomu bou\u0159\u00ed a l\u00e9\u010dit se necht\u011bj\u00ed. To se pak \u010dasto projevuje v m\u00edrn\u00e9 form\u011b t\u00edm, \u017ee pacient je v\u016f\u010di l\u00e9ka\u0159i protivn\u00fd a neochotn\u011b odpov\u00edd\u00e1 na ot\u00e1zky ji\u017e p\u0159i sepisov\u00e1n\u00ed anamn\u00e9zy, v hor\u0161\u00edm p\u0159\u00edpad\u011b je drz\u00fd nebo i vulg\u00e1rn\u00ed. Pak ov\u0161em nem\u00e1 smysl ve vy\u0161et\u0159en\u00ed v\u016fbec pokra\u010dovat. P\u0159irovn\u00e1v\u00e1m to n\u011bkdy k situaci, kdy by do zubn\u00ed ordinace p\u0159i\u0161el k o\u0161et\u0159en\u00ed \u010dlov\u011bk, kter\u00fd by necht\u011bl otev\u0159\u00edt \u00fasta. Co potom m\u016f\u017ee l\u00e9ka\u0159 d\u011blat?
\nNejednou se psychiatr setk\u00e1 se situac\u00ed, kdy za n\u00edm p\u0159ijdou p\u0159\u00edbuzn\u00ed \u010dlov\u011bka, kter\u00fd se je\u0161t\u011b nikdy psychiatricky nel\u00e9\u010dil a podle jejich n\u00e1zoru by to pot\u0159eboval. P\u0159\u00edbuzn\u00ed obvykle l\u00ed\u010d\u00ed chov\u00e1n\u00ed posti\u017een\u00e9ho, ze kter\u00e9ho l\u00e9ka\u0159 m\u016f\u017ee u\u010dinit p\u0159edb\u011b\u017en\u00fd z\u00e1v\u011br, \u017ee se jedn\u00e1 t\u0159eba o psychickou poruchu, nebo \u017ee pit\u00ed alkoholu skute\u010dn\u011b p\u0159esahuje m\u00edru. A \u017ee by tedy psychiatrick\u00e9 vy\u0161et\u0159en\u00ed a l\u00e9\u010den\u00ed byly \u017e\u00e1douc\u00ed. Tyto situace b\u00fdvaj\u00ed velmi sv\u00edzeln\u00e9, proto\u017ee p\u0159\u00edbuzn\u00fd posti\u017een\u00e9ho m\u00e1 n\u011bkdy p\u0159edstavu, \u017ee psychiatr m\u00e1 n\u011bjak\u00e9 mo\u017enosti potenci\u00e1ln\u00edho pacienta do ordinace p\u0159iv\u00e9zt, poslat pro n\u011bj n\u011bkoho se sanitkou apod. To psychiatr nem\u00e1. N\u011bkdy tak mus\u00edme vysv\u011btlovat, \u017ee v ordinaci nem\u00e1me z\u0159\u00edzence, kte\u0159\u00ed by d\u011blali podobn\u00e9 v\u00fdjezdy do ter\u00e9nu. S klientem ale m\u016f\u017eeme jeho situaci podrobn\u011b rozebrat a poradit mu postup, jak m\u00e1 rodina posti\u017een\u00e9ho p\u0159im\u011bt k l\u00e9\u010db\u011b. Jen\u017ee rada je jedna v\u011bc a akce je v\u011bc druh\u00e1. M\u00e1lokomu z p\u0159\u00edbuzn\u00fdch se chce j\u00edt s posti\u017een\u00fdm do konfliktu a k l\u00e9\u010db\u011b ho p\u0159inutit. Zejm\u00e9na se to t\u00fdk\u00e1 pij\u00e1k\u016f alkoholu, kte\u0159\u00ed b\u00fdvaj\u00ed v opilosti agresivn\u00ed a rodinn\u00ed p\u0159\u00edslu\u0161n\u00edci se jich boj\u00ed. Ale nelze jinak. Kdo jin\u00fd m\u00e1 nap\u0159. otce rodiny, kter\u00fd prop\u00edj\u00ed v\u00fdplatu, nebo dokonce bije \u017eenu, donutit k l\u00e9\u010db\u011b ne\u017e rodina sama? Mohou samoz\u0159ejm\u011b pomoci soci\u00e1ln\u00ed pracovnice, ale i pro n\u011b je situace mnohdy t\u011b\u017eko \u0159e\u0161iteln\u00e1. Na druh\u00e9 stran\u011b je pochopiteln\u00e9, \u017ee slab\u00e1 \u017eena se opil\u00e9ho man\u017eela-agresora boj\u00ed, zejm\u00e9na kdy\u017e nec\u00edt\u00ed pomoc dal\u0161\u00edch \u010dlen\u016f rodiny.<\/p>\n
Mor\u00e1ln\u00ed dilemata<\/p>\n
Jin\u00e1 situace nast\u00e1v\u00e1, jestli\u017ee p\u0159\u00edbuzn\u00ed l\u00e9ka\u0159i sd\u011bluj\u00ed p\u0159\u00edznaky vysoce rizikov\u00e9, jako nap\u0159. to, \u017ee pacient mluv\u00ed o sebevra\u017ed\u011b nebo \u017ee se doma chov\u00e1 tak nebezpe\u010dn\u011b, \u017ee by mohl t\u0159eba nezav\u0159\u00edt plyn, nevypnout elektrick\u00fd spot\u0159ebi\u010d apod., tak\u017ee by mohl zp\u016fsobit n\u011bjakou pohromu. V tom p\u0159\u00edpad\u011b psychiatr m\u016f\u017ee po\u017e\u00e1dat praktick\u00e9ho l\u00e9ka\u0159e, aby v rodin\u011b ud\u011blal n\u00e1v\u0161t\u011bvu, situaci posoudil a pacientovi l\u00e9\u010den\u00ed na psychiatrii doporu\u010dil. P\u0159ekvapiv\u011b to \u010dasto m\u00edv\u00e1 kladn\u00fd efekt. Jindy je mo\u017eno poradit p\u0159\u00edbuzn\u00fdm, aby v p\u0159\u00edpad\u011b vyhrocen\u00ed situace zavolali rychlou z\u00e1chrannou slu\u017ebu.
\nV ka\u017ed\u00e9m p\u0159\u00edpad\u011b v\u0161echny situace, kdy pacient nesouhlas\u00ed s psychiatrick\u00fdm l\u00e9\u010den\u00edm z jak\u00fdchkoliv d\u016fvod\u016f, jsou velmi o\u0161idn\u00e9 a pro l\u00e9ka\u0159e nep\u0159\u00edjemn\u00e9. L\u00e9ka\u0159 se pohybuje na ost\u0159\u00ed no\u017ee. Ne\u0159e\u0161it potenci\u00e1ln\u00ed psychick\u00e9 poruchy \u010dlov\u011bka, na kter\u00e9ho byl upozorn\u011bn, je \u0161patn\u00e9. Zbyte\u010dn\u00fd psychiatrick\u00fd z\u00e1sah u osoby, kter\u00e1 je zdrav\u00e1 a kter\u00e1 to m\u016f\u017ee opr\u00e1vn\u011bn\u011b vn\u00edmat jako poru\u0161en\u00ed sv\u00fdch pr\u00e1v a stigmatizaci, je tak\u00e9 \u0161patn\u00e9. Takov\u00e1to rozhodnut\u00ed jsou n\u011bkdy opravdu obt\u00ed\u017en\u00e1 a n\u00e1ro\u010dn\u00e1 – po str\u00e1nce odborn\u00e9 i mor\u00e1ln\u00ed.<\/p>\n
—<\/p>\n
<\/p>\n
O autorovi: Helena Ku\u010derov\u00e1, AUTORKA Autorka m\u00e1 psychiatrickou ordinaci v Hranic\u00edch na Morav\u011b.<\/p>\n
Psychologie dnes<\/p>\n","protected":false},"excerpt":{"rendered":"
Jist\u011b to zn\u00e1te. M\u00e1te nemocn\u00e9ho p\u0159\u00edbuzn\u00e9ho, ale ten tvrd\u00ed, \u017ee mu nic nen\u00ed, a k doktorovi ho prost\u011b nem\u016f\u017eete dostat. Zvl\u00e1\u0161t\u011b mu\u017ei to berou n\u011bkdy […]<\/a><\/p>\n<\/div>","protected":false},"author":1,"featured_media":12720,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[9],"tags":[],"class_list":["post-26656","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\/26656","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=26656"}],"version-history":[{"count":0,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/26656\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/media\/12720"}],"wp:attachment":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=26656"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=26656"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=26656"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}