Modern psychiatry no longer looks as frightening as is commonly believed from still popular stereotypes. The image of a violent patient who toils and destroys everything in a solitary room with iron doors and bars on the windows is now just a horror story from the past. Today it is common to consult a psychiatrist even at the first symptoms of depression, and you can receive adequate help. Severe psychoses are no longer a death sentence, and people who have gone through them can often return to active life. social life. All this was made possible thanks to the power of people who wanted to change psychiatry forever.
Creation of the first psychiatric hospital
Back in the 18th century there was no psychiatric hospitals– there was bedlam. Bedlam is an institution where mentally ill people were brought in the most serious condition, when relatives could no longer tolerate them at home or it was dangerous. In essence, these were shelters that were maintained by inviting spectators for money. Adults and children went to bedlams, like a theater or a zoo, and observed the strange and frightening behavior of the possessed and insane. The mentally ill were kept in chains. They howled, screamed, muttered something, made faces, begged, and made incomprehensible movements.
It is easy to guess that the idea of mental illness At that time it was very bright, and still excites the curious.
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In 1793, a young doctor, Philippe Pinel, was appointed to a Parisian shelter, who for the first time decided to remove the chains from the sick. His view of mental illness was somewhat different from that of his other colleagues. He was the first to say that crazy people are sick people and they need help.
The decision to remove the chains from the patients caused a great stir in the city. Even the head of the Paris commune came here to check that the enemies of the revolution were not hiding here under the guise of being sick. But when it became clear that Pinel was firm in his decision, all attempts to avoid the strange innovation were abandoned.
All the servants of Bicêtre bedlam fled: they were afraid that the madmen would tear them to pieces as soon as they gained freedom. Of course, nothing like that happened. Pinel and his friend remained in Bicêtre and began to treat the mentally ill to the best of their ability at that time. But the most important thing in the new approach was not in the treatment methods, but in the attitude towards patients. Attention to simple human needs and care had a beneficial effect and healed the soul of the mentally ill.
As soon as it became clear that Pinel’s approach gives mentally ill people the opportunity not only to live out their days in torment, but also to have hope for recovery, bedlam began to be repurposed as psychiatric hospitals throughout Europe.
Philippe Pinel taught psychiatry at medical university until 1822, and was even Napoleon’s consulting physician.
At the age of 80, the sick and frail old man Pinel died in poverty.
But even now there are institutions for the mentally ill, similar to the bedlam of the 18th century. Indonesian shelters are filled with unfortunate people who live in cages and chains.
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Opening of psychiatric outpatient clinics: free hospital visits
Another person who was able to change a cruel system is Clifford Beers. At the beginning of the 20th century, he was forced to undergo treatment in one of the US psychiatric hospitals for three years. The conditions in which the patients were in the hospital led him to the decision to radically change the organization psychiatric care.
MentalHealthAmerica was born in 1909, the first public organization mentally ill, which still leads active work. Its founder was Clifford Beers. The result of Mental Health America was the opening of psychiatric outpatient clinics, where patients could come during the day, for a few hours, and then return home.
This approach was very unusual for psychiatry, but it made it possible to provide adequate psychiatric care not only for severe psychoses (schizophrenia, manic-depressive psychosis), but also for neurotic disorders: fears, phobias, obsessions. It also made it possible to monitor patients during the period of remission, and help them if necessary, even before psychosis sets in again.
This change again forced psychiatrists to think about the nature of mental illness and stimulated them to search for new methods of treatment.
Nevertheless, in large-scale psychiatry there were still strict measures for keeping patients in order to combat agitation and aggressive behavior during acute phase psychosis was nothing. Bars on the windows, heavy, heavy furniture, iron doors, straitjackets: all this protected both the hospital staff and the patients themselves. It was not possible to fully implement Pinel’s ideals in psychiatry even in the 20th century.
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Discovery of aminazine (chlorpromazine) - the first antipsychotic
In the mid-20th century, psychiatry received its first effective drug.
In 1952, Jean Delay and Pierre Deniker created the drug chlorpromazine, which was intended to calm agitated patients. This changed the entire approach to treatment in psychiatry. Now there was no need to be protected from patients by iron bars, and treatment became more humane, and patients had the prospect of returning home after a difficult period.
Before this, psychiatrists practiced lobotomy, electroconvulsive therapy, insulin comas, and infection with three-day malaria ( heat reduced mortality from progressive paralysis). All these methods were effective to some extent, and even reduced mortality in psychiatry. But the treatment process was more like torture.
Now psychiatrists had a drug that could be administered to patients regularly, stop agitation and help patients fit into normal life even after severe psychosis.
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The disadvantage of the first antipsychotics was their destructive effect on the personality and physical health sick. At long-term use aminazine and haloperidol develops neuroleptic syndrome. But it was still better than what the patients received before.
Aminazine (chlorpromazine) became the basis for the creation of more advanced drugs that can now be used for a long time without causing severe personality changes.
Now psychiatry has modern medicines, the use of which can be combined with the usual lifestyle.
The number of mental patients has increased 40-fold over a hundred years since the beginning of the 20th century. But this does not mean that there are more unhealthy people. This is evidence that psychiatry can now help even with disorders that were previously overlooked.
Natalya Trokhimets
The trial in the case of Mikhail Kosenko, whom the court sentenced to compulsory treatment, caused a new wave of discussion about the structure of Russian psychiatric institutions. Human rights activists are talking about a “renaissance of punitive medicine”: it is almost impossible to leave some psychiatric institutions, and monitoring commissions enter them with great difficulty. Nevertheless, medical experts are urged not to draw far-reaching conclusions. Let's try to figure out how psychoneurological boarding schools are organized - the most extensive part of the Russian psychiatric system.
With love and all sorts of abomination
Gray high-rise building, Northern Butovo. In a typical two-room apartment that smells of fish soup, lives a former boiler mechanic at the local thermal power plant, Mikhail Kolesov. Frail, baby-faced, 60-year-old Mikhail is dressed in sweatpants and a darned turtleneck; the furnishings in his apartment are ascetic: no TV, no computer, the furniture is simple kitchen set, three beds, table, wardrobe. The wallpaper in the hallway has faded, and a nameless black and white cat walks along the hallway.
Once upon a time, his wife Nadezhda and daughters Anya and Masha lived in the same apartment. My past life Kolesov recalls with mixed feelings: “My wife was too intelligent, she worked in the patent literature office, she didn’t care about me, she towered over me, although when we first met she was not at all arrogant.”
Problems with their common daughters, Anya and Masha, began after school: “The daughters studied somehow, somehow graduated from vocational school. Then they got a job: Anya as a gardener in a greenhouse at VDNKh, Masha as a cook in a cafe,” recalls Kolesov. “One day Masha went away, excuse me, out of need, and they said to her: “Why didn’t you wash the dishes, we had to wash the glasses.” Once, they fired me. Then Anya left work, she didn’t like it. They began to live at home without anything to do, as freeloaders. They didn’t look for service at all, they just listened to music all day long and hung out with the boys. My wife decided that they should get a disability pension.”
The chief psychiatrist of the Saratov region, Alexander Parashchenko, heads the Regional Psychiatric Hospital named after. Saint Sophia is 19 years old. "Russian Planet" talked to him about his condition modern psychiatry, and at the same time politics. It turned out that a return to traditional values and a stable society in many cases has a more stabilizing effect on the collective unconscious than drugs and technical devices.
– Alexander Feodosievich, some experts say that the processes of modernization of medicine have led to positive changes, but there are shortcomings everywhere. In some places there are not enough qualified doctors, in some places the problem cannot be solved with medicines. What problems are most acute today in your clinic and other hospitals in the region?
– Everyone has the same explanation - there is not enough money. But there are other problems. There is often a lack of proper arrangement even of what people have. There are not enough doctors, nurses, and qualified personnel. Here I am a doctor, I worked for many years. But today it’s hard for me to imagine that in this situation I would become a doctor today. Probably he would, but it would be tantamount to a feat! And this is the decision of young people today - to become a doctor, I evaluate it as equivalent to a feat!
Today in society the motives for quick success and easy enrichment are overdeveloped. With a normal professional career as a doctor, there is simply no such thing as quick success. Overcoming temptations, the constant struggle with temptations is not just a feat. Uncertainty, lack of guidelines as to which choice is correct - underlie many neuroses and neurotic conditions.
Today, July 30, 2013, an exhibition opened in the Krasnodar Regional Exhibition Hall best works participants of the art studio of the State Budgetary Healthcare Institution “Specialized Clinical Psychiatric Hospital No. 1” of the Ministry of Health Krasnodar region called "Light of the Soul".
Today, art therapy is relevant and in an effective way treatment and social rehabilitation. Psychologists say that creativity and art help a person who finds himself in the “circle of the doomed” to free himself from the burden of unbearable worries, and not only discover, but also fall in love with this world.
The US Army is suffering from an ever-increasing number of suicides among soldiers and is looking for ways to solve this problem. The military sees the development of a special nasal spray with a unique composition that relieves suicidal thoughts as one of these ways. The army is going to allocate $3 million for the development of such a drug.
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Autism is a permanent developmental disorder that manifests itself during the first three years of life and is a consequence of a neurological disorder affecting the functioning of the brain, which predominantly affects children in many countries, regardless of gender, race or socio-economic status, and which is characterized by impaired ability to to social communication, problems with verbal and nonverbal communication and limited and repetitive behaviors, interests and activities. The incidence of children with autism is high in all regions of the world and has enormous consequences for children, their families, communities and societies. Autism spectrum disorders and other mental health conditions among children pose significant economic burdens for families due to often limited health care resources in developing countries. |
On January 12-17, 2010, a charity exhibition-auction will be held in the exhibition hall of the St. Petersburg Union of Artists, where works of artists will be exhibited rehabilitation centers psychiatric hospitals in St. Petersburg.
The goal of the project is to attract public attention to the work of artists with mental disorders and help in the development of rehabilitation centers in Russia.
Transcript of the next thematic meeting held by the Russian Psychotherapeutic Association together with the Bekhterevsky Psychiatric Society: “ Psychotherapy for schizophrenia«.
The meeting took place on December 9, 2009 at 16.00 in the assembly hall of the neurosis clinic
named after academician I.P. Pavlova (at the address: Bolshoy pr. V.O., 15th line, no. 4-6.)
Event program:
1. Opening.
2. Message: “Psychotherapy of schizophrenia”, MD, prof. Kurpatov V. I.
3. Report: “Analytical-system family psychotherapy in working with
families of patients with schizophrenia” Ph.D. Medvedev S. E.
4. Discussion, debate.
6. Miscellaneous.
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Having come into contact with such an exotic art direction as outsider art, and having become acquainted with the history of its development, perhaps the most surprising thing was that the interest in the work of artists with psychiatric experience is not at all a fashionable trend of modern trends.
Back in 1812 American B. Rush, in his work “The Mentally Ill,” admired the talents that develop during the manifestation of suffering. Further, drawings of patients for clinical diagnostic purposes are studied mainly by A. Tardieu, M. Simon, C. Lombroso in the 19th century and R. de Fursak and A.M. Fey at the beginning of the 20th century. In 1857 Scotsman W. Brownie with his work “Art in Madness”, in 1880. Italian C. Lombroso with his work “On the Art of the Mad” and in 1907. their French colleague P. Mondier (under the pseudonym M. Reja) with his work “The Art of Madmen” for the first time defines the status of the subject so highly. |
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Psychiatry is very young medical science, which became independent only by the middle of the 20th century. And until recently, the greatest contribution to the study of higher nervous activity human contributed by researchers fascist Germany who spent their inhumane experiments on people in concentration camps. Based on these data, the approach to treating all mental disorders. But a lot of time has passed since that time, and scientists and psychiatrists have accumulated experience by studying reactions nervous system more humane methods.
In less than 100 years, already from
psychiatry began to stand out as a separate science - Psychotherapy, which
plays, today, no less significant role in treatment
mental disorders than the use pharmacological agents.
And the pharmaceutical industry itself has changed significantly,
the most advanced techniques in manufacturing and creation began to be used
the most complex drugs, and are now quite firmly included in
pharmaceutical industry nanotechnology, with the help of which
A new generation of medicines is being created.
Previously treated for mental illness
Until recently, most
severe mental disorders, up to 80% of all applicants
for psychiatric help, were recommended to begin treatment in a hospital, and
it was completely justified. Until now, psychiatrists and
psychotherapists who take their work seriously and
take care of the condition of the patient who seeks help,
are guided by these principles.
Drugs created using nanotechnology began to act more selectively, and the so-called “side effects” decreased significantly or disappeared altogether.
Medical scientists are penetrating more and more into the secrets of higher nervous activity and can more accurately determine certain disturbances in the functioning of the brain during mental changes in a person. Using complex techniques that combine the adequate use of pharmacological agents, psychotherapeutic techniques and regulation of daily routine and nutrition. A psychiatrist or psychotherapist has significantly more opportunities in selecting individual therapy for mental disorders, which is no longer comparable to the results that could have been obtained even a year ago.
Mental illnesses are treated today
Today, new technologies for treating mental disorders using outpatient methods have been developed and are beginning to be implemented. Through the joint efforts of medical scientists, pharmacologists, biochemists, biophysicists, etc. various countries, by using practitioners psychiatrists, psychotherapists, neurologists, a truly unique technology for treating mental disorders in an outpatient setting has been created.
Studies were conducted over 10 years, which proved the possibility of refusing hospitalization in 80% of cases that were previously recommended for inpatient treatment. In Russia, methods of hospital-substitute forms of treatment of mental disorders and behavioral disorders, and community-based psychiatry and community-based psychosocial rehabilitation have received recognition in the State Scientific Center Social and Forensic Psychiatry named after. V.P. Serbsky, and since 2012 they have been recommended for implementation.
Today these are only the first steps towards a new look at psychiatry and psychotherapy, towards new attitudes towards people suffering from various mental disorders. And, it is likely that in the not distant future the standards will be revised accounting policy in PND.
We hope that many people suffering mental illness who previously did not have the opportunity, for example, to obtain the right to drive a car, will be able to officially do so.
The World Health Organization predicts that by 2020 the number of people suffering from depression will increase exponentially. And now this problem affects at least 5% of the world's population. However, only a little more than one percent of them are aware that they are sick. Two-thirds of those suffering from depression are considering a way to end their life, and 15% are putting their plan into action. What needs to be done to be prepared for timely and effective delivery helping these people, experts are discussing at the All-Russian Congress in St. Petersburg.
While the number of people suffering from severe mental illness has remained virtually constant for many years, the number of those living in the so-called borderline state between illness and health is growing. They suffer from depression, anxiety, sleep disorders and headaches, bulimia and anorexia. However, there is essentially nowhere for them to receive treatment. There is one inpatient psychotherapy department for the whole country (the St. Petersburg Neurosis Clinic accepts only St. Petersburg residents).
– Our patients do not suffer from severe psychiatric disorders, such as schizophrenia, for example. They can and should receive other help in order to continue raising children, working, driving a car,” says Tatyana Karavaeva, head of the country’s first department for the treatment of borderline mental disorders and psychotherapy at the National Medical Research Center named after. Bekhterev. “They cannot be loaded with drugs that make it difficult for them to move their legs; they need to carefully select medications and gradually, with the help of psychotherapy, change the attitudes that led to depressive disorders.
According to Tatyana Karavaeva, indications for hospitalization are severity clinical symptoms with severe manifestations, for example, a person, due to fear, cannot walk down the street, use transport, or be in in public places. Or a person is constantly in a traumatic situation, it hurts him again and again, and he needs to be removed from these conditions. It happens that a person is able to be treated on an outpatient basis, but in inpatient conditions he needs to pick up drug therapy. There are situations in which psychological disorders become overgrown with somatic ones: against a background of anxiety, a person may develop problems with cardiovascular, endocrine systems, With gastrointestinal tract. The need for their correction is also an indication for inpatient care. Simply put, it is needed for those who cannot be treated at home. But there is nowhere to get it in Russia.
– And the point is not even that inpatient psychotherapeutic departments are expensive and require appropriate staffing table With a large number psychotherapists and medical psychologists,” says Viktor Makarov, professor, president of the All-Russian Psychotherapeutic League, head of the department of psychotherapy and sexology of the Russian medical academy continuous vocational education. – There was a period when such departments worked in psychiatric hospitals throughout the country. But about 15 years ago they began to close. And I think that the reason was the jealousy of doctors: in a hospital with 1000 beds there is one department with 60 beds, in which interesting job with safe patients, where all doctors want to work. They began to close them, and “borderline” patients were shoved into different departments of the clinic where “chronics” were treated. But a person with sleep disturbances and headaches will not want to lie with patients suffering from schizophrenia. Those who can, travel from other regions to the department of the Bekhterev clinic, because in the regions, even in Moscow, there are no psychotherapy departments where they treat not only with pills. In Moscow, such patients are immediately prescribed 5-7 medications. And it is important for a person to avoid this - to avoid the phenomenon of “delayed life”, when he thinks that he is being treated today and will start living tomorrow. As a result, only a few Russians in so-called borderline conditions receive effective medical care.
At the same time, the system of mental health care in the country is not only not preparing for the growing need for psychotherapy, but everything is heading towards the fact that problems with obtaining it will worsen. In St. Petersburg alone, 1,245 psychiatric beds have been cut over three years with the intention of transferring patients to receive care in outpatient facilities, including day hospitals. At the same time, psychotherapeutic beds are not being added.
– We need a reorganization of the service, and not a thoughtless reduction of beds; we need to train specialists who are in short supply. The Ministry of Health plans to adopt a new professional standard for a psychiatrist, which today has been formed in such a way that it can eliminate the specialty “psychotherapy” - the specialty “psychiatry” is being introduced with the labor function “psychotherapy,” says Tatyana Karavaeva. – The Russian Psychotherapeutic Association sent proposals to the Ministry for the preservation of the specialty, for the interaction of a psychotherapist with a medical psychologist, as well as for the training of these specialists.
At the congress, another appeal will be made to the Ministry of Health with proposals for changes in regulatory documents on the provision of psychiatric care. For example, there are still no standards for the number of patients a doctor should see; the issues of workload, training, and delimitation of the functions of a medical psychologist and psychotherapist have not been determined. Experts also raise objections to proposals to shift the prescription of drugs for the treatment of depression to therapists (general practitioners).
– Finding a psychotherapist in a clinic is a very great success, often unattainable, experts say. - So treat patients with anxiety states or with depression there will be therapists - more precisely, they will prescribe medications. And this is not simple drugs, they have many side effects, there are specific indications and contraindications, and there are problems with drug withdrawal.
Psychiatry, like any other science, does not stand still. Approximately every ten years, the classification of diseases and treatment methods in psychiatry is revised. Modern treatment involves a complex of biological effects and psychotherapy, coupled with actions aimed at social and labor rehabilitation.
New treatments in psychiatry suggest correctly established diagnosis, the degree of the patient’s condition, taking into account the characteristics of the patient’s personal characteristics. Usually when in serious condition the patient is subjected to drug treatment, and at the stage of recovery and recovery from psychosis, they prefer psychotherapeutic methods of influence. The patient's condition, the severity of the disease and its severity determine the method of administering medications. They are usually prescribed for oral administration in the form of tablets, dragees, injections, and drops. Sometimes, for speed of action, the intravenous method is used. All medications are carefully analyzed for side effects and contraindications.
Drug treatment is carried out both on an outpatient and inpatient basis, depending on the patient’s condition and his desire. For pronounced pathologies, it is prescribed hospital treatment, which, as recovery progresses, is replaced by outpatient care. Outpatient use to restore stabilization or remission. Biological therapy implies an impact on biological processes patient, which are the cause mental pathologies.
Treatment methods in psychiatry are not limited to treatment with medications. There is such a direction of psychotherapy as psychopharmacology. Until recently, the range of drugs from this series was very meager: caffeine, opium, valerian, ginseng, bromine salts. In the mid-twentieth century, aminisine was discovered, which marked a new era in psychopharmacology. New methods have appeared thanks to the discovery of tranquilizers, nootropics, and antidepressants. Nowadays, the search continues for new substances that would have best action with the least side effects. Psychotropic drugs are divided into several groups. Neuroleptics are used to eliminate perception disorders and are the mainstay of treatment for psychosis. Can be taken orally and intramuscularly. Long-acting antipsychotics are used in outpatient clinics. When taken in large doses, side effects may occur, manifested in the form of hand tremors, stiffness of movement, and cramps in individual muscles. These effects can be caused by the use of Moditene Depot, Smap, etc. But Eglonil and Leponex do not cause the above actions. If side effects occur, correctors are prescribed.
Tranquilizers include seduxen, phenazepam, elenium, tazenam, etc. These are drugs used to calm the patient, relieve emotional tension and excessive anxiety. Causes drowsiness. Each tranquilizer has its own benefit. Some calm you down, others relax you, and others put you to sleep. These features are taken into account by the doctor when prescribing. In view of wide range action tranquilizers are used not only for mental illnesses, but also for other somatic diseases.
Antidepressants are designed to improve depressed mood and eliminate inhibition of actions. Antidepressants come in two types: stimulant and sedative. Stimulants include drugs such as melipramine, nuredal, and are used in cases where, along with a depressed mood, the patient’s speech and speech are slowed down. physical activity. And sedatives (tryptisol, amitriptyline) are used in the presence of anxiety. Side effects when taking antidepressants there are constipation, dry mouth, cardiopalmus, drooling, decreased blood pressure. But they are not dangerous to the patient’s health, and the attending physician can help eliminate them. Treated with antidepressants various types depression.
Nootropics (metabolic drugs) consist of drugs that differ in chemical structure and mode of action, but they produce the same effect. Nootropics are used to increase mental performance, improving memory and attention. Nootropics are used for many mental disorders, to relieve hangover syndrome in patients suffering from alcoholism, with dysfunction cerebral circulation. There are no side effects observed.
Mood stabilizers (or lithium salts) normalize erratic moods. Taken by patients with manic-depressive psychosis and periodic schizophrenia for the prevention of manic and depressive attacks. Patients have their blood drawn periodically to monitor serum salt levels. Side effects occur due to overdose or somatic diseases.
New in psychiatry - insulin-shock therapy and ECT. Insulin shock therapy is used in the form of a nonspecific stressor effect on the patient’s body, the purpose of which is to increase its defenses, that is, the body begins to adapt as a result of shock, which leads to its independent fight against the disease. The patient is given a daily increasing dose of insulin until the onset of symptoms of low blood sugar and a coma, from which they are removed by glucose injections. The course of treatment is usually 20-30 com. Similar methods in psychiatry can be used if the patient is young and physically healthy. It is used to treat some forms of schizophrenia.
Method electroconvulsive therapy is that the patient is exposed to electric current are called seizures. ECT is used in cases of psychotic depression and schizophrenia. The mechanism of the effect of current is not fully understood, but it is associated with an effect on the subcortical brain centers and metabolic processes in the central nervous system.
New treatments necessarily involve the use of psychotherapy. Psychotherapy involves the doctor influencing the patient’s psyche with words. The difficulty lies in the fact that the doctor needs to achieve not only the patient’s favor, but also “penetrate” the patient’s soul.
There are several types of psychotherapies:
· rational (the doctor explains something reasonably through dialogue),
· suggestive (suggestion of some thoughts, for example, dislike of alcohol),
· suggestion while awake, hypnosis,
· self-hypnosis,
· collective or group psychotherapy,
· family, behavioral.
All the described treatment methods are widely used in modern psychiatry. Nevertheless, scientists do not stop looking for new, more advanced methods of getting rid of mental pathologies. New treatment methods are always agreed upon with the patient or his relatives if the disease excludes the patient’s legal capacity.
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