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The medical-social rehabilitation of patients with epilepsy in out-patient conditions


Author: Oleg Cobâleanschi
Degree:doctor habilitat of medicine
Speciality: 14.00.18 - Psihiatrics and Narcology
Year:2005
Scientific consultants: Stanislav Groppa
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Anatol Nacu
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:
Scientific council:

Status

The thesis was presented on the 19 October, 2005
Approved by NCAA on the 22 December, 2005

Abstract

Adobe PDF document0.44 Mb / in romanian

Thesis

CZU 616.853-08.039.76

Adobe PDF document 1.58 Mb / in romanian
239 pages


Keywords

epileptic attacks, partial epilepsies, generaliyed epilepsies, potentially psycho-physical remain, psycho-pharmalogical therapy, ont-patient recovery, functional rehabilitation centre, readaptation, resocialization

Summary

The study followed and examined 259 patients with epilepsy in out-patient conditions for which plenary recovery assistance was applied for a long term and by which they had to be within the actions planned of psychotherapeutical rehabilitation which could foresee both specific medication (psychopharmatherapy) and measures of motor and speech habits including by interventions of bringing about compensatory mechanism, taking care of the social reinstatement of the epileptic patients through institutions of rehabilitation or active supervision. Conditions of out-patient assistance were preferred within which they could benefit of a complex functional examination (ECG, Eco-E, REG).

The investigations made on the origin of difficult epilepsies included in this study revealed the fact that the substrate of organic sequelae of a significant importance are the etiological factors from childhood, puerperal pathology, hypoxy, neuroinfections, hereditary in adults – TCC, alcoholism, emotional stress, insomnia, overstrain and other asthenic moments to which hereditary predisposition in added.

The specific examinations both clinical and paraclinical tests, the investigation study and the tests of evaluation and self-evaluation accumulated a big number of useful information to make the programs for psychopharmacological assistance and complex recovery successive for the patients with various and difficult species of epilepsy.

Thus it was established and assessed as distructive factors which hastened the manifestation of the disease, then factors and circumstances which cause the starting of the attacks and maintain the progressing of the disease. To make the assessment of the remaining psycho-physical potential, of the degree of intellectual disfunction, detailed studies have been performed to investigate and self-estimation in terms of quality and social adaptation of each patient under observation.

The information was used to arrange differentiated programs for patients with epilepsy of recovery assistance which included both specific medication and a various spectrum of psycho-social assistance different individual kinds of psychotherapy, including self-training suggestive psychotherapy, in groups, psichoterapeutical sessions with the family, occupational therapies, sociotherapy, out-patient sociotherapy, which stipulates the including of patients in different programs of recovery and strengthening of psychic and professional abilities, possibly of reorientation to less required professions, but which will maintain within social activities.

The experience accumulated during these studies was systematized, assessed to its efficiency and assigned more indications of followed-up supervision of patients with epilepsy at primary level of medicine, making clear recommendations to observe these patients and orientative indications to reintegrate them in their families in micro and macro social companies. The author worked out some programs of complex psychopharmacological assistance, suggesting solutions for adaptation of the proposed forms in some certain cases which may impose the change of some programs of recovery assistance or prevent early depersonalizations.

The author outlined obvious principles of assistance in stages, through which should be avoided the exclusion of the patient from medical actions and social protection, at the some time, some suggestions of professional consulting, instructive, matrimonial and assistance being made for persons with epilepsy, which have the right to be involved in the production of social goods and benefit of them.