Natural science

The future of psychiatry – outpatient treatment and rehabilitation of patients and their families

Mental Health conference in MSU 2016

Currently, in Russia and in the world there is a new approach to psychotherapy taking into account modern challenges and scientific discoveries. Conference “Mental health: social, clinical, organizational and scientific aspects” was intended to discuss actual issues on 31 October 2016 in the MSU, with the participation of leading specialists of scientific and practical directions of psychiatry in Russia. The General sponsors of the conference are the pharmaceutical company Johnson and Johnson and Pfizer.

The main trends of development of psychiatry in Russia

The number of beds in psychiatric hospitals decreased by almost half in Russia since 2012. There are 62 beds in Moscow for 100 thousand inhabitants, while in Germany – 2.5 times more. Today in the international practice adopted the so-called deinstitutionalization – that is, the reduction of psychiatric hospitals in the number together with attempts to integrate patients to the home environment and society. This trend did not bypass Russia

What are the major trends in the Russian psychiatry? This question we addressed to one of the conference’s speakers Professor Kostyuk G. P., who told us the following: “The development of psychiatry has two aspects: one institutional, the other scientific and clinical.

In the organizational aspect the trend mental health care is shifting from the hospital to extramural forms of psychiatric care. This is, first of all, better for the patient, and it allows him to quickly get out of the world of illness and to return to normal society.

As for the scientific aspect, then, of course, we are talking about the development of the early, but accurate and timely diagnosis. It is necessary to diagnose the disease not earlier, but in a timely manner. The diagnostic accuracy will allow us to make the right choice of drugs.

Now a very wide range of medicines called antipsychotics is known. The point of its application is psychosis, for example, schizophrenic psychosis. There are three dozen kinds of such drugs, and it is sometimes necessary for the patient to sort out the drugs in order to understand which of them will be effective. Thus, the search of test systems that would allow to “get” from a drug – it is the main trend of scientific research in psychiatry”.

Based on the report of Z. I. Kekelize, outpatient treatment will include widely distributed economic mechanism of public-private partnership. In partnership with private business, the practice of psychiatry medical-industrial workshops, designed to contribute to the rehabilitation and socialization of patients will return again. Tax holidays for entrepreneurs (tax No. 477 FZ) will play key role in the operation of the mechanism.

Other important things for the layman on modern psychiatry

Psychiatry today tends to penetrate deeper into disease and treatment processes, to improve the adopted methodology. “It is necessary to think of the mental health of the child a month before the trip to the registry office” – said Professor Z. Kekelidze. For those who are thinking about IVF (so-called in vitro fertilization, test tube), it would be helpful to know that psychiatrists overdue study of the mental characteristics of such children and highlight them in a separate group.

In his report, Z. Kekelidze also said that today 40% of students have a diagnosis of “school maladjustment”. The importance of the problem encouraged to introduce the discipline “Psychology” into the school, which will be studied in a 3-11 school grades. The course will be included in the programme of pedagogical institutes too. Textbooks will be ready in 2017.

Many psychiatrists talked about other age-related problems, the effects of the spiritual state of the person and the relationship of the so-called depression (depression) of the disease.

Prof. Neznanov N. talked about the fact that depression is most common at the age of 15-44 years, women affected it in 2 times more often than men. Depression directly effect on a mental illness. For example, today the leading cause of death in Russiais heart disease, and depression affects heart disease. More than 50% of cancer patients are the mentally disadvantaged.

Chronic depression creates a risk of senile dementia and Alzheimer’s disease. According to Z. Kekelidze, 47.5 million people worldwide suffer from senile dementia, 60-70% of which is Alzheimer’s cases, and the rest is vascular dementia. It is important to diagnose the disease at an early stage and to establish a system of medical and social care for patients and their families.


Psychiatry affect households and related disciplines. For example, in Russia today there is many drug addicts and alcoholics – trend of consumption of Datura consciousness peculiar to the world, and we have the scale of a national catastrophe. It is associated primarily with genes, but also with the psyche of teenagers and their fascination with new subcultures with their social environment and upbringing.

To date, 1/3 of the types of disability are associated with mental illness, it is a problem of society. The economy also adjoins the need to improve the testing of psychotropic drugs, the introduction of new drugs, working on insurance medicine.

Psychotherapy is involved in a specific political situation that requires medicine efficiency of treatment in order to achieve concrete results in practice. But, according to Z. Kekelidze, “it is important to understand what is the finished case”.

On the other hand, the political situation also affects society and, in particular, is changing the pattern of incidence of the psyche. According to the report of academician A. Tiganov, “Atypical forms have become increasingly characteristic of our time, but typical turned unusual”. Hence there is the need for continuous improvement of scientific knowledge and skills for treatment.

I would like to complete the article philosophically, with comments of prof. A. Bobrov on the fact that our society does not believe in healing mentally ill people: “This view is incorrect. It is due to stigmatization (labeling – approx. ed.). From the point of view of the biologist, man is someone called Homo Sapiens (or wise man). In the definition there is already laid the mind. But if a person has a label that he is mentally ill, then it seems not reasonable. This is one of the manifestations of the so-called stigma. Actually, the mind is a very complex concept. And to label “I am reasonable, and you are unreasonable,” there is a very big simplification. For some functions, such as fleet management, capacity… this can make a difference. But in relation to other functions such as family relationships, parenting, friendship it doesn’t work as would work in other areas. For example, if the person is incapacitated that he cannot love? Or may not have children? I don’t know, is it always necessary, but there is a question of ethics. Not everything can be solved uniquely in the matter of mental disorders

Probably many of our readers will have to think about the meaning of mental deseases.

Person psychiatry mentioned in the article:

Kekelidze, Zurab , Professor, MD Chief freelance psychiatrist of the Ministry of healthcare of Russia, Vice-President of the Russian Union of psychiatrists, Director of the “FMIZP them. V. P. Serbsky”.

Georgy Kostyuk, Professor, M. D., Chief psychiatrist of Moscow, chief physician of GBUZ “Psychiatric hospital № 3 them. V. A. Gilyarovsky,” Colonel, medical service reserves.

Alexey Bobrov, Professor, MD head of the Department of psychiatry and consultation psychiatry, Moscow research Institute of psychiatry.