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The active development of psychosocial rehabilitation (PSR) has been taking place in Russia within latest two decades. In this regard, analysis of the accumulated experience and problems’ identification in the PSR field is relevant.
Conducting a sociological study in the Volga Federal District (VFD) to work out measures for further PSR system development.
Sociological, statistical, original semi-structured questionnaire on PSR application, including 26 questions.
63 institutions providing psychiatric care in 14 large regions of the VFD participated in the study. Achievements in the field of PSR include: introduction of new forms of rehabilitation care, modern psychosocial interventions; development of the volunteer sector and others. A number of systemic problems were also identified: more pronounced decrease in the availability of psychiatrists in VFD compared to the Russian Federation (RF) as a whole (in the VFD 0.76 psychiatrists per 10 thousand population in 2017 and 0.74 per 10 thousand population in 2018; in RF: 0.83 psychiatrists per 10 thousand population in 2017, 0.82 per 10 thousand in 2018); insufficient provision with psychotherapists, psychologists, social workers, which varies considerably in different territories (up to 10 times); insufficient use of non-profit organizations’ (NPOs) potential; lack of a unified system for assessing PSR effectiveness.
Measures for development of PSR were proposed: improving staffing levels and qualifications of employees, introducing psychosocial interventions with proven effectiveness; dissemination of successful experience of NPOs, development of methodological tools for assessing effectiveness of PSR, its standardization and others.
The current stage of research on mental disorders is associated with the use of system approaches to the development of the scientific foundations of psychiatric care.
Approach to solving problems that arise in the diagnosis of psychopathological conditions, assessing their severity, as well as evaluating the effectiveness of psychosocial treatment and rehabilitation.
Clinical, psychometric, system analysis methods and algorithms of the Analytical Hierarchy Process (AHP)  were used.
When assessing a patient’s condition and behavior, it is necessary to make decisions (diagnosis, development of treatment and rehabilitation plans) based on heterogeneous information (genetic, neuronal and environmental, involving individual characteristics, as well as family and social context). This information is hierarchically organized and includes quantitative and qualitative data. Exposure at each of these different levels can affect the onset and course of the disease, and therefore should be considered in primary prevention and subsequent psychosocial therapy and rehabilitation of patients. Analysis of the problems of assessing psychopathological states and related psychosocial problems shows that these problems can be presented in the form of appropriate hierarchies, the structure of which must be taken into account when processing the initial information. The main advantages of the AHP include the use of the relationship scale (fundamental scale) for processing heterogeneous data based on expert, clinical information.
The approach provides correct integration of heterogeneous characteristics when considering diagnostic procedures, psychosocial therapy and rehabilitation.1. Mitikhin V.G., Solokhina T.A. S.S. Korsakov Journal of Neurology and Psychiatry, 2019, 2: 49-54. doi:10.17116/jnevro201911902149
The reform of the Moscow psychiatric service began in 2011 and was aimed at its optimization, reducing the inpatient level, actively introducing psychosocial rehabilitation, multidisciplinary teams of specialists and developing community-based forms of care. In 2016, the number of beds in day care hospitals in Moscow had doubled to rich 3500.
Analyze the dynamics of characteristics of day hospital patients and propose measures to improve the quality of medical rehabilitation care provided.
Clinical and psychopathological, clinical and statistical, psychological, statistical of 337 schizophrenia patients discharged in 2010 and 2016.
A comparative analysis of the results obtained in 2010 and 2016 indicates a change in the clinical, socio-demographic and psychological characteristics of patients treated in the day hospital. In 2016, the proportion of early stage disease patients with endogenous mental disorders (F20-F29, according to ICD-10) increased; the age of patients and the proportion of patients with disabilities decreased; the proportion of patients with preserved working capacity increased, demonstrating low rates of compliance and motivation for treatment, but higher rates of neuro-cognitive functioning. In 2016, only a fifth of patients received complex psychosocial therapy.
The modernization of the psychiatric service has improved the continuity between its inpatient and out-of-hospital units. To improve the quality of care in the day hospital and to prevent relapses of the disease, it is necessary to combine pharmacotherapy with complex psychosocial treatment followed by a long-term personalized management of patients with the patient’s families involvement.
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