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An important aspect of rehabilitation programmes is assessment of their effectiveness, which is carried out mainly through clinical and psycho-pathological examinations, psychometric and psychological scales and questionnaires. The use of biological markers of the schizophrenic process to assess the effectiveness of rehabilitation assistance is of considerable interest.
To compare the clinical and socio-psychological characteristics of schizophrenia patients receiving psychosocial treatment in various forms of psychiatric care with the level of immune system activation reflecting the activity and severity of the pathological process in brain.
77 schizophrenia patients in remission of varying quality were examined, of which 52 patients (the 1st group) participated in a long-term comprehensive rehabilitation programme (3.7±2.5 years) in non-profit organization, and 25 patients (the 2nd group) received medical and rehabilitation assistance in the psychiatric day hospital (duration of treatment no more than 60 days). PANSS, HDRS, SAS-SR, SF-36, BRS scales were used. The activity of the pathological process was evaluated by the level of inflammatory markers.
Both patient groups showed a similar increase in the level of inflammatory and autoimmune markers compared to control (p<0,01). The 1st group compared to the 2nd one had a significantly higher level (p<0,05) of social functioning, stress resistance, awareness of the disease, motivation, comprehensiveness, as well as less the severity of psychopathological symptoms.
The results indicate the effectiveness of a long-term comprehensive rehabilitation programme to stabilize clinical remission, improve social functioning and the quality of life in schizophrenia patients, despite the active pathological process in brain.
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
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