of course, i want a little more specifics, so i am asking the residents of the occupied forest wall and surrounding villages who may see me now, look carefully at the photo, 13-year-old melania chumak looks her age and has dark eyes and light blond hair, ivan also has dark eyes and light blond hair, he looks 16:17 years old, the children live in the village of lisna stynka street lisna building 5 if someone can visit them and check if everything is ok with them or if anyone has already seen them call us at the children's search service at with the short number 116,000 from any mobile operator, calls are free or write to the chat bot of the child search service in telegram, even a little news that everything is fine with melania ivan will greatly reassure their mother

, congratulations, i am iryna koval and this is a program about health during the war war in our country , air strikes continue every day, rockets fly into different cities, civilians die every day, children, military doctors, volunteers and journalists , people are under occupation, hiding in basements, and bomb shelters, we see a lot grief and even those who seem to have held on at the beginning and were strong now feel mental exhaustion and i will tell you that this is absolutely normal because we all feel the consequences of the war, everything that happens has a negative effect on our and your mental health. heard such an abbreviation as ptsd is post-traumatic stress disorder today we will discuss what it is how does it manifest itself and is it

really a threat to everyone, and the most important thing is what to do with it in today's conditions, every person needs to know about it first of all in order to timely diagnose and provide psychological and medical help, preventing the dangerous development of ptsd, this is a mental reaction to severe stress or trauma , according to statistics, women suffer from ptsd more often than men, and by the way, not only war can provoke the appearance of ptsd in a person, it can be accidents these can be disasters, natural disasters, violence , a negative experience of childbirth, the death of a loved one, but not every stress can be spent before the appearance of tsn. now they complain of anxiety, insomnia , irritability and panic attacks. but this does not

mean that you already have post-traumatic stress disorder, because those who really have it are unlikely to be able to cope on their own and need the help of specialists. why is it important not to postpone a visit to the doctor for later? with the new explosion, the cities got worse and worse. i was shaking with bessia. i just fell on my knees and prayed. katya, a resident of oboloni. this is one of the districts of kyiv where, in the first days of the war, a rash girl broke in for almost two weeks. i hid in the shelter of one of the universities. there was no sunlight, no fresh air, only eerie sounds and fear above us. battles were going on, tanks were driving, saboteurs were running, and at the same

time there was a battle on the dam near the kyiv sea. the battle that was taking place outside, the neighbor said that the sky was simply red from the shelling. after two weeks, the girl and her family went to live with relatives in the west of ukraine, but russian rockets are still flying there, so after sleepless nights, katya went to where safe and although the danger for the girl of the past, the anxiety has not disappeared, every sharp sound, every flight of an airplane or a helicopter throws me into the cold when it flies, i just wait to see if it will fly further or not and inside, everything goes down about most of its symptoms katya is not ready to talk to anya ani's camera with a specialist, reluctance to talk about the experience is a very common manifestation of post-traumatic

stress disorder, says a psychologist who works abroad with refugees from the occupied territories. they want to talk about what they lived through, how they passed, how they left ukraine, and the psychological consequences - this is only the beginning , a month passes, uh, there are already some physical symptoms, that is, people feel bad, they feel broken, when we conduct diagnostics, we see that in terms of health , everything seems to be fine. this is also a manifestation of post-traumatic stress disorder when crossing the state border. refugees undergo a medical examination and often consult a psychologist themselves, but the internal movement of persons who left hell to relatively safe places regions less often show such a desire and close in on themselves and this in the future

threatens not outpatient treatment but inpatient inpatient departments, all overloads caring for your psychological health is not just a wish or a trend, it is a duty to your body, especially now in the conditions war, you need to listen to yourself and if you notice the symptoms, contact a specialist. this is increased curiosity . generalized anxiety and fears, according to psychiatrists, one should not hope that the problem will go away in time without consulting a doctor with such symptoms can not only ease the psychological state of the patient, but also prevent more serious complications when at first we are talking about insomnia and irritability , which is quite well amenable to treatment then

more serious mental disorders join, these are severe depressions, suicides, and probably the most terrible thing is that these are suicides, they already exist, so about 8% of men and 20% of women who experienced traumatic events have ptsd these statistics were published by the ministry of health of ukraine. if nothing is done, it can end in the destruction of relationships, work, health, or even life. just now, in the story, they talked about the suicidal consequences of ptsd. it is possible to overcome or learn to manage it if you recognize the symptoms, diagnose and undergo treatment so, the symptoms that indicate that you need help are constant thoughts about a traumatic event, they occur involuntarily , you may dream or manifest as

flashbacks of life in full combat readiness or the person has obsessive thoughts about his own safety consciously avoiding mention of the trauma panic attacks are such as a feeling of intense fear shallow breathing dizziness nausea rapid heartbeat and pain behind the sternum emotional emptiness detachment from loved ones and loss of interest in the past favorite things mistrust and troubles in everyday life there may also be abuse of alcohol, cigarettes and drugs problems in relationships sleep disorders attentiveness and ptsd also has such physical manifestations as constipation digestion, hypertonicity of the muscles, tachycardia, it can be chronic pain, headaches, diarrhea , or a feeling of tightness and burning behind the sternum

, cramps and pain in the lower back. who should be contacted is the family doctor, so how many complaints are there now about the symptoms of post-traumatic stress disorder and how family doctors act in such cases, we will find out by contacting us from the family doctor, professor of the department of family medicine, therapy, cardiology and neurology, zaporizhzhia state medical university, iryna voloshina, ms. iryna, i greet you. good afternoon, iryna, thank you for the invitation . now patients are presenting with ptsd symptoms, and are we talking about the threat of an increase in such cases in the future after the end of the

war? i would say an epidemic or even a pandemic in us in ukraine of mental disorders and diseases and this is again official data - these are forecasts of the world health organization because war is a global risk factor for the development of any mental disorder, therefore there will definitely only be an increase in appeals - an increase in statistical indicators but i would say that what we see as statistics is only the tip of the iceberg, because in reality, well, i don't know if 20-30%, in my opinion, is still much more than our population now, uh, already have uh ptsr of one or another degree of expressiveness and when you listed and the psychologist listed the symptoms, and when they said that the state of constant alertness, i looked around and looked

. and there is a suitcase next to me, and here , that is, and i think that i am also not alone in that the state of constant alertness is present in every resident of ukraine, where mr. iryna, tell me, are there any cases among your patients where a person who experienced stress during the occupation, for example, was already evacuated abroad and already sought help from there, because we know a lot of stories that are now being told by them already known to the whole world, they tell us that in european countries it is not so easy for ukrainians to get medical help right away, they have to go through the bureaucracy of these procedures, so do our citizens who are abroad turn to you and actually turn to you for advice on what to do and an algorithm on how to act in one or another country, because indeed the countries, even the eu, have very different systems of providing medical care and,

for example, those people who are already under the control of the state, for example, poland, germany or france provided such at least temporary insurance where the insurance policy they can contact the nearest family doctor without hindrance and he will already give the first advice or will already delegate to a specialist for the determination of such serious indicators, and of course here the language barrier is a very serious obstacle, that's why i know now there are a lot of our people abroad. they are looking for russian -speaking or ukrainian-speaking doctors, of course , there are simply more russian-speaking doctors , that is why the emphasis is rather on them, that they are simply easier to find, but they are looking specifically for an understanding language, because when we talk about the conduct of mental disorders, in particular ptsd panic attacks as one of the options of the eteser, here understanding of language so that there is no language barrier

is extremely important in ukraine, i can also say that i am now leading the direct mobile brigade of the de-occupied territories of kyiv region and what we see we actually consulted more than 1,000 patients in a month, that's all . let's say it's all people, but very many of them also have symptoms that require referral not only to a psychologist, but even to a psychiatrist before hospitalization, and here what you showed in the plot, i can say that there are places, what you said that inpatients are overcrowded, maybe this is not entirely true now. if a person needs hospitalization , he can even without a referral from a family doctor directly contact a psychiatrist, what is located in a polyclinic near the inpatient facility or it is possible to the reception department of the hospital itself and no one will refuse the help of mrs. iryna, how do you diagnose ptsd because, well, when we talk about the fact that people can apply and simply

call to get a consultation by telephone or online consultation, or simply to diagnose ptsd in general, for example, without any personal contact. i mean when we communicate with a person who is nearby, and here you know. the question is, after all, how important is this definition to the patient in the word petesr yes, for example, we have the icpc-2 classification that we use at the primary link and we have such a point there e acute reaction to stress or reaction to stress or just stress stress disorder anxiety disorder that is, we indicate symptom, main symptom, what the person complained about, that is, if a person complains of a panic attack, we write the reason for the complaint

panic attack. psychiatrist, if the family doctor delegates the family doctor, the family doctor does not have such a task, that is, to issue such a rigid differential diagnosis , we conduct it symptomatically, and if we see that there is a symptom, one of the symptoms of ptsd, we use it we record and provide appropriate recommendations on what to do next for the person and what these recommendations can be. is this recommendation to go to a psychiatrist or a special psychologist again? well, for example, there are questionnaires for determining what is a stress disorder and an anxiety disorder and a depressive disorder. the diagnosis takes from one to five minutes, and it can be done by sitting the patient either at a computer or sent or mollink to the questionnaire so that it was passed

, then just showed the number of points or in the presence of the doctor already on if i printed out such questionnaires, any method can be used to confirm, after all, the reason for the application and here is the question about recommendations, i will immediately say what should not be done. neither the client nor the doctors should first of all start with heavy psychotropic drugs, and there is such a drug of the gasoline group, and it is generally such a serious enough group of drugs and in it is written in each of the instructions for ptsd that do not start, do not prescribe groups without gasoline for zapini with ptsd, because it can cause serious harm. and in general, any medical treatment should be treated with caution, this should already be done as one of the very next steps, that is, i want to start by thanking you to thank you, we will talk about treatment and drugs later. and i

thank you for contacting us and for your advice. for your consultation, we were contacted by iryna voloshina, professor of the department of family medicine, cardiology therapy and of neurology of the zaporizhzhia state medical university and there are several protocols for the treatment of ptsd and none of them is exhaustive and universal. for each person, the approach and medication should be selected individually, but still , taking into account the protocol and the circumstances of life and how psychiatrists treat ptsd and what are the features of this mental disorder . let's find out right now and contact us doctor psychiatrist psychotherapist candidate of medical sciences associate professor svitlana netrusova mrs. svitlana it's nice to see and hear you today i congratulate you good day irina i'm also very glad to see and hear you and all our listeners and i am very glad to have the opportunity

to help with some advice and knowledge to share what those who suffer from pcr or someone in this traumatic situation is and may be at risk of developing pcr ms. svitlana please tell me how many patients you currently have with ptsr well, i want to say that i don't have so many patients that i can make a percentage sample of my own er, i mean experience, i mean my practical activity but if we take the general sample, up to 30% of the general population can suffer from post-traumatic stress disorder . and those people who have experienced violence or have had er were participants in such traumatic events, such a traumatizing event from the war right now. there is no

need to talk about violence against women or about other moments there is a fire or something else or something else, we have a war and this is a big, very powerful, psycho-traumatic factor that can lead to post-traumatic stress disorder, and it is precisely in such people who are experiencing such a stressful a powerful factor up to 30% of people can develop post-traumatic stress disorder and i really have 30% of you, i really have a lot of questions today, so let's be more concise and give more clear answers. increase in the number of ukrainians with such a diagnosis, and if so, when should we predict this beginning, because we talked at the beginning of the program about the fact that ptsd

was already developing when everything was over , but we know that there are people who, for example, there they have now gone abroad, yes, it may be over for them, it is possible and no, so when should this start when will everything begin? i want to say that traumatic stress first occurs - this is when, up to two days ago, a person experienced some traumatic situation there, whether bombs were falling or they were hiding in basements or did they lose someone close to them or did they leave and shoot them in the back, that is, up to two days - this is traumatic stress, acute stress disorder from two days to four weeks . after four weeks after the psychotraumatic event happened and i want to tell you that it can be very long, it can even continue for

months and even years if it is not treated , this post-traumatic stress disorder is basically a war is still going on and people can suffer from post-traumatic stress disorder during the war not only when it ends four weeks after they survived the bombing there before four weeks when they survived and and further not necessarily after four weeks you can well no well not earlier than after 4 weeks to four weeks this is an acute stress disorder and in this case this is a post stress dramatic disorder if it is not treated if it is not dealt with seriously it can lead to certain very serious violations . if there is an opportunity, i will tell you what these are the main clinical manifestations and it is necessary to contact the specialists of psychologists , psychiatrists, psychotherapists in order to

help yourself and if the psychologist is not available as a doctor, he does not have the right to make a diagnosis, only a psycho-psychiatrist has the right to make a diagnosis, only a single specialist legally has the right to make this diagnosis, and i want to say that if a psychologist at certain stages no longer helps people cope with this condition, if we are talking post-traumatic stress disorder, then it is necessary to consult a psychiatrist, because this is the specialist who deals with the treatment of this development of ms. svitlana. however, i understand that not all people who have experienced this stressful event develop ptsd. is there any criteria for these people, and the most vulnerable contingent is the women's children, as well as it depends on the conditions of the person who has experienced a stressful situation. for example, if she is

among those people who are experiencing a stress disorder and a stressful factor together with her, then it is easier to bear together er, all together these are these experiences, as well as certain characteristic features of a person, a certain story. well, in quotation marks, it ensures the occurrence of certain neurotic disorders, which includes post-traumatic stress disorder, there are certain people who are anxious people who are people who er more er how they perceive all negative factors more seriously and more traumatic than other people, people behave differently and people experience differently and then give er if the answer to this negative factor this also applies to ms. svitlana's post-traumatic stress disorder. then, since you see that every person is an individual, let's talk about

how not to miss this symptom, because a person cannot always correctly assess , for example, his psycho-emotional state and probably in this there are more hopes for her environment, what behavior of a person should attract attention and give this signal that she already needs the help of a specialist well, if we are talking about post-traumatic stress disorder, then a very important issue is not only sleep disturbance, the appearance of anxiety, excessive inner restlessness er irritation of increased certain vegetative manifestations that can give increased anxiety or anxiety, this is an increase in pulse and pressure and er, diarrhea can be flatulence, bloating, which can lead people lead to specialists of a different profile , therapeutic cardiologists or gastroenterology, although in fact it is increased

anxiety, i have repeatedly told about it on my my channel to you. i also tell about somatic manifestations of anxiety, but the main such symptom of post-traumatic stress is such flashbacks, this is such a symptom, such manifestations of e- when they occur in people who have experienced a certain stressful factor and they develop a post- traumatic stress disorder, that is, these are such sudden memories of these psycho-traumatic events and a person experiences as vividly as she does, as if she experienced it all again now, and these flashbacks trigger certain triggers, such external stimuli, irritants that can arise , for example, in some life situations, manifest themselves. for example, if people, for example, hear a helicopter flying, they can

perceive it as such the trigger and they may have this flashback, such a symptom of post-traumatic stress disorder, when they vividly remember all the events that they experienced and which were very traumatizing. was it the bombing? was it the loss of loved ones of people or will it be ms. svitlana and what should it be ? rockets are already flying over there. so something is exploding and it lasted for such a long time . what was a person supposed to do? it was just some kind of list or a person was supposed to cry somehow, because we all understand

what we are in such a case if we say two words about these flashbacks, what can happen in connection with, for example, salutes that are launched by those people who do not understand that this can lead to a flashback ? it can be, for example , heightened anxiety in the evening, there can be, uh, in the trees, some kind of person sees a silhouette and thinks that it is some kind of person, some uh, man who wants to, who can bring danger to this person, it can be, for example , when not only the rumble of an airplane or an airplane or a helicopter or uh these uh this uh it can even be the same thunder that you are talking about, well, i always said that if

a person wants to experience this reaction and he wants to cry, he must cry, if he wants to scream, he must scream, if he wants to kill something, find some dishes, some dishes or something that does not beat so that it is possible to beat safely and in this way physically er-e manifest to emit steam so-called that is in this in this case er-e i understand that thunder we can not cancel and we cannot cancel any fireworks if people with next to us will want to celebrate their birthday even though it's wrong but dear such a noise dear rumble dear sound dear sight of blood or somehow red paint it can remind a person of something he can't remind he will be a trigram that will start this flashback and a person will be ... to remember so vividly and to experience these

feelings as if they were now at this moment at this moment but there is already i want so i listen to you we have literally three minutes left i want to talk with you more about treatment for tsn and already now there are ongoing discussions about the legalization of medical cannabis in ukraine and the use of documents based on it for the treatment of people with ptsd and you know it is no secret for you that it is a common practice in the world to use drugs from medical cannabis precisely for the treatment of such disorders, they do not cause addiction or dependence so i want to ask you what is your opinion and here er what do you think this treatment should be and does medical cannabis have the right to be present here i want to tell you that before a person has yet turned to a specialist and she is worried about it all, she has to take all the sedatives that just sit down, relieve anxiety, reduce and

calm down and i really respect er, it was very good the interview of my previous er, i mean the professor who spoke very well about the family doctor's pt, but i can disagree with her well, i have my own opinion on this, as you said, i have a lot of e-e protocols, but they are all different. that is, i cannot say that tranquilizers are a group of tranquilizers to which belongs our well-known gidazepam, which everyone knows and everyone can to buy on white, not on red prescriptions, but you can take it for no more than a month and there is nothing wrong with it. if a person takes it and calms down, if he can calm down his anxiety and calm down thanks to taking this drug, which belongs to the class of tranquilizers, it is not at all scary drugs of the anti-psychotic series