Проблема комплаенса в психиатрии

The article presents an overview of major Russian and foreign literature on the problems of compliance in patients with schizophrenia. The article describes key factors associated with the patient's refusal of the prescribed treatment. The article describes the basic methods of evaluation of compliance: experimental and psychological, with applied clinical significance. The article describes the main factors associated with the patient's refusal of the prescribed treatment, describes the contribution of low compliance not only to the patient's quality of life, but also to the health care costs associated with repeated hospitalizations of non-compliant patients. The article examines methods for overcoming non-compliance in patients with schizophrenia, for example, compliance therapy - a psychotherapeutic method that is short-lived, convenient and simple to use in clinical practice, and has shown rather high efficiency.В данной статье представлен обзор основных российских и зарубежных источников литературы, посвященных проблемам проверженности лечению (комплаенса) у пациентов, страдающих психическими расстройствами, в частности шизофренией. В статье описаны основные факторы, ассоциированные с отказом больного от назначенного лечения, описан вклад низкой комплаентности не только в качество жизни пациента, но и в расходы системы здравоохранения, связанные с повторными госпитализациями некомплаентных пациентов. В статье также рассматриваются методы оценки комплаенса, как экспериментальные, так и клинико-психологические, имеющие прикладное клиническое значение. Кроме того, в статье изучаются методы преодоления нонкомплаентности у больных шизофренией, например, комплаенс-терапия - психотерапевтическая методика, отличавшаяся краткосрочностью, удобством и простотой для применения в клинической практике и показавшая достаточно высокую эффективность

Некоторые актуальные вопросы организации психиатрической помощи в стационаре

The first results of psychiatric service reform in the Russian Federation using an example Moscow Clinical Psychiatric Hospital № 13 of the Moscow Healthcare Department are considered in the article. Main attention is paid to organization of activities and results of functioning of the hospital in new conditions, effectiveness of patient treatment for the period from 2015 to 2017 is determined. Distribution of patients treated in the hospital by nosological forms of mental illness, by age, gender and professional status is analyzed. Main indicators of the activity of a psychiatric hospital were examined: average duration of a patient’s stay in a hospital, bed occupation rate in a year, bed turnover, number of bed days. Attention is drawn to the primary disability of patients, number of repeated admissions to hospital, problems of involuntary hospitalization. Analysis of financing of inpatient psychiatric care for treated patients for the studied period is performed. The main direction for the provision of psychiatric care to patients at the present stage is defined as outpatient care, hospital-replacing services.В статье рассматриваются первые итоги реформирования психиатрической службы в России на примере Московской клинической психиатрической больницы № 13 Департамента здравоохранения г. Москвы. Основное внимание уделено организации деятельности и результатам функционированию стационара в новых условиях, установлена эффективность лечения больных за период с 2015 по 2017 г. Проанализировано распределение пациентов, пролеченных в стационаре, по нозологическим формам психических болезней, по возрасту, половой принадлежности и профессиональному статусу. Исследованы основные показатели деятельности психиатрического стационара: средняя длительность пребывания больного в стационаре, работа койки в году, оборот койки, число койко-дней. Обращено внимание на первичный выход больных на инвалидность, количество повторных госпитализаций в стационар, проблемы недобровольной госпитализации. Проведен анализ финансирования стационарной психиатрической помощи по пролеченным больным за исследуемый период времени. Определен основной вектор оказания психиатрической помощи больным на современном этапе как внебольничный, стационарозамещающий

Group Analysis in Patients with Somatoform Disorders: Clinical Effectiveness, the Dynamics of Quality of Life and Attitude Towards Disease and Treatment

Background: the application of group analysis for the treatment of somatoform disorders requires the substantiation of its clinical and psychological effectiveness in various differential diagnostic groups. Aim: the investigation of the dynamics of pathological bodily sensations, concomitant psychopathological symptoms, quality of life as well as beliefs about the disease and treatment in patients with somatoform disorders undergoing group analysis, in comparison with patients in the psychoeducation program. Patients and methods: 100 patients with somatoform disorders were randomized to group-analysis or psychoeducation. Before and after treatment, they filled Screening for Somatoform Symptoms, the Toronto Alexithymia Scale, the Illness Perception Questionnairie revised, Cognitions about Body and Health Questionnaire, Scale for the Assessment of Illness Behaviour, and Quality of Life Enjoyment and Satisfaction Questionnairie-18. Results: all patients demonstrated a decrease in the severity of somatoform symptoms and an improvement in the quality of life in various spheres of life, which is significantly more pronounced in patients receiving group-analysis compared to psychoeducation. The improvement of subjective state of patients having undergone psychotherapy during treatment was highly associated with a decrease in the severity of the emotional reaction to the disease, somatosensory amplification, beliefs in bodily weakness and intolerance to bodily sensations. The patients of the main group solely demonstrated a decrease in patterns of hypochondriacal behavior such as catastrophization regarding bodily sensations, revisiting general practitioners, and simultaneous distrust of the results of medical tests and prescriptions. When comparatively analyzing the separate diagnostic groups, patients with polymorphic somatoform disorder displayed the most pronounced clinical effect (a decrease in the severity of complaints) in the process of group analysis, and patients with somatized disorder showed the most pronounced psychological effect (an improvement in the quality of life, a decrease in the dramatization of bodily sensations, a decrease in medical retesting and diagnosis verification, the optimization of beliefs about health). Conclusions: group analysis demonstrated greater clinical and psychological effectiveness, in comparison with psychoeducation, in patients with somatoform disorders. © 202

Hypochondriac Beliefs and Behavior in Patients with Somatoform Disorders: Relationship to Somatic Complaints and Subjective Well-Being

Background: studies of the psychological mechanisms of perpetuation and quality of life in patients with somatoform disorders are important for identifying targets for psychological interventions and defining risk groups. Aim: to reveal specific hypochondriac beliefs and behavior in patients with somatoform disorders related to severity of somatic complaints and subjective well-being. Patients and methods: 100 patients with somatoform disorders were assessed by using Screening for Somatoform Symptoms, Toronto Alexithymia Scale, Cognitions About Body And Health Questionnaire, Scale for the Assessment of Illness Behaviour, and Quality of Life Enjoyment and Satisfaction Questionnaire-18. Results: level of somatoform symptoms is higher in patients with a tendency to catastrophize bodily sensations, autonomic disfunction, mental scanning for bodily symptoms, and disturbances in daily activities due to illness. Regardless of somatoform symptoms’ severity, subjective well-being is lower in patients with belief in bodily weakness and somatosensory amplification, autonomic sensations, expression of symptoms, and changes in daily activities due to illness. Conclusions: the results are discussed in the context of possible psychological and behavioral factors in the perpetuation of somatoform disorders. Patients of older age are at risk of perpetuation of somatoform disorders due to a greater tendency to catastrophize bodily sensations and higher belief in bodily weakness. © 2021, Medicinskoe Informacionnoe agentstvo. All rights reserved

К вопросу об актуальности работы амбулаторного психиатрического модуля (социологический аспект)

Results of a sociological survey among doctors and patients on the implementation and operation of a new organizational form - outpatient psychiatric unit - operating on the basis of the Psychiatric clinical hospital No. 13, Moscow Healthcare Department, is presented in the article. Advantages of this organizational form in comparison with hospital treatment are shown: reduced treatment period, proximity, volumes of treatment comparable with hospital treatment, maximum social adaptation of patients. Some problematic issues of the unit’s operation are identified: lack of continuity in the interaction between the individual structures of the new organizational form, as well as with other health care organizations.В статье приведены результаты социологического опроса, проведенного среди врачей и пациентов, о внедрении и работе новой организационной формы - амбулаторного психиатрического модуля, действующего на базе Государственного бюджетного учреждения здравоохранения «Психиатрическая клиническая больница № 13 Департамента здравоохранения города Москвы». Показаны преимущества данной организационной формы в сравнении со стационарным лечением: сокращение сроков лечения, территориальная доступность, получение объемов лечения, сравнимого со стационарным, наибольшая социальная адаптация больных. Определены некоторые проблемные вопросы работы модуля: недостаточная преемственность во взаимодействии между отдельными структурами новой организационной формы, а также с другими медицинскими организациями