{"id":4450,"date":"2016-03-14T12:18:12","date_gmt":"2016-03-14T12:18:12","guid":{"rendered":"https:\/\/jurmed.ro\/pacienti\/?p=4450"},"modified":"2016-03-14T12:21:55","modified_gmt":"2016-03-14T12:21:55","slug":"tulburari-ale-consumului-de-alcool-si-alte-substante","status":"publish","type":"post","link":"https:\/\/jurmed.ro\/pacienti\/tulburari-ale-consumului-de-alcool-si-alte-substante\/","title":{"rendered":"Tulbur\u0103ri ale consumului de alcool \u015fi alte substan\u0163e"},"content":{"rendered":"

\"Silhouette<\/a><\/p>\n

\u00a0 \u00a0 \u00a0Problemele legate de consumul de alcool reprezint\u0103 o parte important\u0103 a cazuisticii \u00eent\u00e2lnite \u00een practica serviciilor de \u00eengrijire medical\u0103 primar\u0103. Se estimeaz\u0103 c\u0103 p\u00e2n\u0103 la 20% dintre persoanele care se adreseaz\u0103 unui medic de familie \u015fi p\u00e2n\u0103 la 40% dintre pacien\u0163ii sec\u0163iilor de medicin\u0103 general\u0103 \u015fi chirurgie, f\u0103r\u0103 diferen\u0163e semnificative \u00eentre specialit\u0103\u0163i, au consumul de alcool la originea cererii de asisten\u0163\u0103 medical\u0103. Rom\u00e2nia se situeaz\u0103 \u00een topul \u021b\u0103rilor europene av\u00e2nd un consum estimat la 14.4 l alcool pur\/capita (la o medie european\u0103 de 10,9 l\/capita). Totu\u0219i, conform OMS (2010), o treime\u00a0 (32.4%) din popula\u021bia adult\u0103 a Rom\u00e2niei nu a consumat alcool \u00een ultimele 12 luni. Aproximativ 55 de milioane de europeni adul\u021bi – 15% din popula\u021bia adult\u0103 \u2013 se \u00eencadreaz\u0103 la un consum riscant de alcool (definit ca o medie de consum de minim 20g-40g de alcool pe zi pentru femei \u0219i 40 g-60g pe zi pentru b\u0103rba\u021bi). Consumul problematic de alcool este unul din cei mai importan\u021bi factori de risc pentru morbiditate, invaliditate \u0219i mortalitate. \u00a0Este implicat cauzal \u00een peste 200 de boli \u0219i afec\u021biuni.<\/p>\n

\u00a0 \u00a0 \u00a0\u00cen practica clinic\u0103, un consum problematic de alcool poate lua \u00eenf\u0103\u0163i\u015f\u0103ri multiple, duc\u00e2nd adesea la nediagnosticare \u015fi pierderea \u015fansei de a se efectua o interven\u0163ie cu adev\u0103rat eficace. Foarte adesea, pacien\u0163ii nu fac leg\u0103tura \u00eentre consumul lor de alcool \u015fi problematica somatic\u0103 \u015fi\/sau psihologic\u0103 pentru care solicit\u0103 un consult medical. De exemplu, vor raporta o simptomatologie gastrointestinal\u0103, dar nu vor men\u0163iona un consum de alcool \u00een cantit\u0103\u0163i mari. Frecvent\u0103 este \u015fi situa\u0163ia \u00een care pacien\u0163ii pur \u015fi simplu nu realizeaz\u0103 c\u0103 beau cu mult peste limita admis\u0103; \u00een acest caz, simpla informare cu privire la cantitatea zilnic\u0103 de alcool validat\u0103 medical se poate constitui \u00eentr-o interven\u0163ie cu mare impact.<\/p>\n\n\n\n\n\n\n
PROBLEMA<\/strong><\/td>\nPREZENTARE<\/strong><\/td>\n<\/tr>\n
COMPORTAMENTAL\u01cd<\/strong><\/td>\nProbleme familiale, de slujb\u0103, legale; leziuni provocate de violen\u0163a domestic\u0103, accidente sau alte ac\u0163iuni violente; probleme maritale; divor\u0163; rezultate \u015fcolare slabe<\/td>\n<\/tr>\n
PSIHIATRIC\u01cd<\/strong><\/td>\nTulbur\u0103ri afective (de ex., depresie), tulbur\u0103ri de personalitate, alte tulbur\u0103ri legate de consumul de alte substan\u0163e, inclusiv abuzul de nicotin\u0103<\/td>\n<\/tr>\n
MEDICAL\u01cd<\/strong><\/td>\nHipertensiune, acuze gastrointestinale, neuropatie, niveluri patologice ale enzimelor hepatice, macrocitoz\u0103, anemie, trombocitopenie, osteoporoz\u0103, disfunc\u0163ii menstruale, cancer de s\u00e2n, boal\u0103 hepatic\u0103 terminal\u0103<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

\u00a0 \u00a0 \u00a0 O categorie popula\u0163ional\u0103 la care abuzul de alcool poate fi u\u015for trecut cu vederea este reprezentat\u0103 de v\u00e2rstnici. Spre deosebire de restul popula\u0163iei, la v\u00e2rstnici impactul social al consumului de alcool este mai limitat, \u00een schimb primeaz\u0103 efectele negative la adresa s\u0103n\u0103t\u0103\u0163ii, uneori ascunse sub masca depresiei, tulbur\u0103rilor de somn, accidentelor, simptome de tip confuzional.<\/p>\n

\u00a0 \u00a0 \u00a0\u00cen cazurile de dependen\u0163\u0103 mai avansat\u0103, poate ap\u0103rea sevrajul, ca urmare a reducerii sau a \u00eentreruperii bru\u015fte a consumului de alcool (de ex. \u00een urma unei fracturi cu imobilizare la pat). Acesta include cel pu\u0163in dou\u0103 din urm\u0103toarele: hiperactivitate a SN autonom, tremor al m\u00e2inilor, insomnie, grea\u0163\u0103 \u015fi\/sau v\u0103rs\u0103turi, iluzii sau halucina\u0163ii tranzitorii, agita\u0163ie psihomotorie, anxietate, convulsii grand mal<\/em>. Sevrajul complicat cu delirium tremens (DT), de obicei precedat de convulsii este o urgen\u0163\u0103 \u015fi trebuie tratat. DT netratat are o rat\u0103 a mortalit\u0103\u0163ii de p\u00e2n\u0103 la 20%.<\/p>\n

\u00a0 \u00a0 \u00a0S-a constatat c\u0103, din popula\u0163ia general\u0103 arondat\u0103 unui centru de \u00eengrijire medical\u0103 primar\u0103 doar 50% dintre consumatorii problematici de alcool iau decizia de a face un consult, iar dintre ace\u015ftia 50% r\u0103m\u00e2n nedepista\u0163i \u015fi\/sau nu sunt trimi\u015fi spre servicii specializate. De aceea, av\u00e2nd \u00een vedere eficien\u0163a \u00een timp a interven\u0163iilor precoce, se contureaz\u0103 mai clar rolul medicilor din serviciile de medicin\u0103 primar\u0103 sau din alte servicii medicale \u015fi chirurgicale \u00een screening-ul consumatorilor problematici de alcool.<\/p>\n

\u00a0 \u00a0 \u00a0Un sistem eficient de tratament \u015fi \u00eengrijire a pacien\u0163ilor cu probleme legate de consumul de alcool ar trebui s\u0103 asigure, pe de o parte, o bun\u0103 comunicare \u015fi proceduri flexibile de trimitere de la un serviciu la altul, iar pe de alta, o bun\u0103 rela\u0163ie cu restul sectoarelor medicale \u015fi \u00een primul r\u00e2nd cu cel de asisten\u0163\u0103 medical\u0103 primar\u0103, de unde s\u0103 fie recruta\u0163i pacien\u0163ii depista\u0163i \u00een urma activit\u0103\u0163ii de screening. \u00cen prezent, este impropriu s\u0103 discut\u0103m despre un sistem rom\u00e2nesc de tratare a problemelor legate de consumul de substan\u0163e. \u00cencep\u00e2nd cu preven\u0163ia primar\u0103 \u015fi sf\u00e2r\u015find cu programele de reinser\u0163ie \u015fi reabilitare a fo\u015ftilor dependen\u021bi, diversele servicii func\u0163ioneaz\u0103 mai degrab\u0103 izolat unele de altele. Serviciile existente tind s\u0103 fie accesate de pacien\u0163i de obicei \u00een situa\u0163ii de criz\u0103, detoxifierea este adesea singura interven\u021bie disponibil\u0103 \u0219i, nefiind urmat\u0103 de alte interven\u0163ii psiho-sociale, rata rec\u0103derilor este mare. De aceea este necesar\u0103 identificarea unor servicii post-detox care s\u0103 preia pacientul dup\u0103 \u0219ederea \u00een spital \u0219i s\u0103-i ofere programe structurate de tratament adecvate severit\u0103\u021bii dependen\u021bei sale de substan\u021b\u0103.<\/p>\n

World Health Organization.\u00a0Global status report on alcohol and health-2014<\/em>. World Health Organization, 2014<\/p>\n

Dr. Eugen Hriscu, medic specialist psihiatru.<\/p>\n","protected":false},"excerpt":{"rendered":"

\u00a0 \u00a0 \u00a0Problemele legate de consumul de alcool reprezint\u0103 o parte important\u0103 a cazuisticii \u00eent\u00e2lnite \u00een practica serviciilor de \u00eengrijire medical\u0103 primar\u0103. Se estimeaz\u0103 c\u0103 p\u00e2n\u0103 la 20% dintre persoanele […]<\/p>\n","protected":false},"author":7,"featured_media":4451,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[67,100],"tags":[378,380,379],"class_list":["post-4450","post","type-post","status-publish","format-standard","has-post-thumbnail","category-articole","category-psihiatrie","tag-alcool","tag-dr-eugen-hriscu","tag-tulburari"],"yoast_head":"\nTulbur\u0103ri ale consumului de alcool \u015fi alte substan\u0163e - Jurmed - Pacienti<\/title>\n<meta name=\"description\" content=\"In acest articol autorul Dr. Eugen Hriscu,\u00a0medic specialist psihiatru.\u00a0ne vorbeste despre tulbur\u0103rile consumului de\u00a0alcool \u015fi alte substan\u0163e\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/jurmed.ro\/pacienti\/tulburari-ale-consumului-de-alcool-si-alte-substante\/\" \/>\n<meta property=\"og:locale\" content=\"ro_RO\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Tulbur\u0103ri ale consumului de alcool \u015fi alte substan\u0163e - 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