Комплексные клинико-социальные исследования в Московском научно-исследовательском институте психиатрии: трансляция в клиническую практику

Статья посвящена работе Московского научно-исследовательского института психиатрии по совершенствованию психиатрической помощи пациентам с психотическими расстройствами. Важной особенностью этой работы являлся комплексный подход, в котором клиническая картина заболевания оценивалась в неразрывной связи с личностными и психологическими характеристиками пациента, социальными условиями его жизни, терапевтическими возможностями, реабилитационным потенциалом и организационной структурой помощи. В статье приводятся результаты многолетней работы отдела внебольничной психиатрии и организации психиатрической помощи под руководством профессора И.Я. Гуровича. Представлены результаты научных исследований, выполненных сотрудниками института в традиционном гуманистическом ключе. Трансляционный характер исследования подчеркивается неразрывной связью с клиническими и социальными подходами.

В результате многолетней работы была разработана концепция оказания помощи различным группам пациентов, начиная с первых проявлений заболевания и заканчивая случаями длительно протекающих хронических расстройств с выраженным уровнем социальной дезадаптации. В результате были предложен целый спектр новых организационных форм психиатрической помощи, таких как отделения (клиники) первого психотического эпизода, медико-реабилитационные отделения, отделения интенсивного оказания психиатрической помощи, предназначенные для наиболее тяжелого контингента пациентов. Данные организационные формы были закреплены в нормативных документах Министерства здравоохранения и социального Развития Российской Федерации. На сегодняшний день вышеперечисленные отделения созданы в психиатрических учреждениях в многих регионах РФ. Дальнейшее развитие данного направления связано с нейробиологическими исследованиями по выделению комплексные биомаркеров расстройств психотического спектра.

Таким образом, исследования, осуществляемые в настоящее время, сохраняют традицию комплексного клинико-социального подхода к изучению психических расстройств. Показано, что важным преимуществом данного подхода является их трансляционный характер.

1. Melekhov DE, Grosman AV. L.M. Rozenshtein and the period of formation of Soviet social psychiatry. In Semenov S.F. ed. Clinical aspects of social rehabilitation of mentally ill patients. Proceedings of the Institute of Psychiatry Vol.73; Мoscow Research Institute of Psychiatry under the Ministry of Health of RSFSR; 1976.
2. Melekhov DE. Clinical basis for prognosis of work capacity in schizophrenia. Мoscow: Med-giz; 1963.
3. Gurovich IYa. On clinical and social criteria for the removal from the dispensary registration of patients with schizophrenia — the final act of social rehabilitation. Questions of the organization of psychiatric care. Мoscow; Мoscow Research Institute of Psychiatry under the RSFSR Ministry of Health; 1982.
4. Gurovich IYa, Sarkisyan VV, Kutsay SI. Subacute conditions in schizophrenia in outpatient practice. Early rehabilitation of mentally ill. Leningrad; Leningradsky Research Psychoneurology Institute, 1984.
5. Sarkisyan VV. Subacute conditions in schizophrenia, their clinic and features of treatment in a day hospital. Dissertation. Мoscow Research Institute of Psychiatry under the Ministry of Health, 1983.
6. Aliskhanov MA. Treatment of patients with schizophrenia in a home-hospital (organizational, clinical and economic aspects). Dissertation. Мoscow Research Institute of Psychiatry under the Ministry of Health of Russian Federation, 2005.
7. Gurovich IYa, Shmukler AB, Storozhakova YaA. Psychosocial therapy and psychosocial rehabilitation in psychiatry. Мedpraktika-M; 2004
8. Lyubov EB. Clinical and social criteria for determining the type of apparent recovery outcomes in schizophrenia (issues of removal from dispensary registration). Dissertation. Мoscow Research Institute of Psychiatry under the Ministry of Health of RSFSR; 1987.
9. Gurovich IYa, Visnevskaya LYa, Shashkova NG, Khudaverdiev VV. Features of the clinic and social adaptation of patients with schizophrenia at the stage of stabilization (based on outpatient practice). In: Smulevich AB, ed. Schizophrenia and schizophrenia spectrum disorders. Мoscow; RAMS MHRC. 1999:77-97.
10. Salnikova LI. Patients with paranoid schizophrenia with persistent adaptation in an outpatient setting. Dissertation. Мoscow Research Institute of Psychiatry under the RF Ministry of Health; 1995.
11. Shmukler AB. Social functioning and quality of life of the mentally ill. Doctoral thesis in Russian. Мoscow Research Institute of Psychiatry under the RF Ministry of Health; 1999.
12. Lyubov EB. Pharmaco-epidemiologic and pharmacoeconomic aspects of mental healthcare for patients with schizophrenia. Doctoral thesis in Russian. Мoscow Research Institute of Psychiatry under the RF Ministry of Health; 2002.
13. Movina LG. Psychosocial treatment of patients with schizophrenia and schizophrenia spectrum disorders with early psychotic episodes. Dissertation. Мoscow Research Institute of Psychiatry under the RF Ministry of Health; 2005.
14. Dorodnova AS. Clinical, social and organizational aspects of psychiatric care for patients with schizophrenia and schizophrenic spectrum disorders with early psychotic episodes. Dissertation. Мoscow Research Institute of Psychiatry under the RF Ministry of Health; 2006.
15. Bessonova AA. The first episode of schizophrenia: clinical, social and pharmacoeconomic aspects. Dissertation. Мoscow Research Institute of Psychiatry under the RF Ministry of Health; 2008.
16. Gebel KM. Dynamics of clinical and medico-psychological characteristics in the process of rehabilitation of patients with schizophrenia who have lost their social connections. Dissertation. "St. Petersburg Research Psycho-Neurological Institute named after V. M. Bekhterev of the Federal Agency for Health and social development of the Russian Federation ”; 2009.
17. Alsakov AA. Patients with schizophrenia with frequent hospitalizations: clinical, social and pharmacoeconomic aspects of anti-relapse therapy with deposited forms of antipsychotics. Dissertation. Мoscow Research Institute of Psychiatry under the RF Ministry of Health; 2003.
18. Shashkova NG, Babushkina EI. Patients with schizophrenia with frequent and prolonged hospitalizations and the prospects for them of alternative forms of care. Article in Russian. Social and Clinical Psychiatry. 2003;13(2):107–111.
19. Davydov KV. Patients with schizophrenia with repetitive prolonged hospitalizations (clinical and social characteristics and integrated community mental healthcare after discharge from hospital). Dissertation. Мoscow Research Institute of Psychiatry under the RF Ministry of Health; 2005.
20. Donenko IE, Shashkova NG, Veschugina TS. Evaluation of the effectiveness of the "Club House" rehabilitation program. Article in Russian. Social and Clinical Psychiatry. 2000;10(4):40-45.
21. Bugrova EI. Noncompliance with the regimen of outpatient psychopharmacotherapy in patients with schizophrenia: clinical, social and economic aspects. Dissertation. Мoscow; 2007.
22. Vasilyeva EA. Comprehensive psychosocial care for patients with schizophrenia and schizophrenic spectrum disorders with a high, not due to clinical indications, referral to psychiatric institutions. Dissertation. Мoscow Research Institute of Psychiatry under the RF Ministry of Health; 2006.
23. Shenderov KV. Clinical and social aspects of care for patients with schizophrenia and schizophrenic spectrum disorders in a day hospital of a psychiatric dispensary. Dissertation. Мoscow Research Institute of Psychiatry under the RF Ministry of Health; 2011.
24. Kiryanova EM. Schizophrenia patients with unstable employment adaptation as a group disability risk. Article in Russian. Social and Clinical Psychiatry. 1993;3(1):29-33.
25. Kiryanova EM. Schizophrenia patients with unstable employment adaptation. Dissertation. Мoscow Research Institute of Psychiatry under the RF Ministry of Health; 1994.
26. Papsuev OO, Movina LG, Kouznetsova OG, Levina NB. Supported Employment Program Trial Within Rehabilitation Unit. Article in Russian. Social and Clinical Psychiatry. 2019;29(1):32-39.
27. Kiryanova EM, Salnikova LI. New approaches to the organization of outpatient care for lonely patients with schizophrenia. Article in Russian. Social and Clinical Psychiatry. 2000;10(1):21.
28. Kiryanova EM, Tkachev DYu. Psychiatric care for patients with schizophrenia and schizophrenic spectrum disorders with ultra-frequent hospitalizations and its comparative effectiveness. Article in Russian. Social and Clinical Psychiatry. 2011;21(4):47-50.
29. Gurovich IYa, Kiryanova EM. On the program to combat stigma associated with schizophrenia. Article in Russian. Social and Clinical Psychiatry. 1999;9(3):5-8.
30. Semenova ND. Psychological and social factors of disability.Article in Russian. In: Current Trends And New Service Models In Mental Healthcare. Мedpraktika-M; 2007:147-162.
31. Papsuyev OO, Visnevskaya LY, Shevchenko VA. Interaction Between Psychiatric Service And Social Care Center. Article in Russian. Social and Clinical Psychiatry. 2008;18(4);69-72.
32. Rivkina NM, Salnikova LI. Working with families in the system of psychosocial therapy for patients with schizophrenia and schizophrenia spectrum disorders with first psychotic episodes. Article in Russian. Social and Clinical Psychiatry. 2009;19(1):65–75.
33. Lyubimova GYu, Levina NB. On the all-Russian society of persons with Mental Health Disabilities and their Families “New Choices”. Article in Russian. Social and Clinical Psychiatry. 2014;24(4):107-108.
34. Gurovich IYa, Shmukler AB, ed. First psychotic episode (problems and mental healthcare). Мedpraktika-M; 2010.
35. Utkin AA. New forms of mental healthcare as part of the system of complex psychosomal therapy and psychosocial rehabilitation. Dissertation. Мoscow Research Institute of Psychiatry under the RF Ministry of Health; 2009.
36. Limankin OV. The system of psychosocial care in a psychiatric hospital for patients with long-term hospitalizations. Dissertation. Мoscow Research Institute of Psychiatry under the RF Ministry of Health; 2007.
37. Stepanova ON. Comprehensive polyprofessional care for patients with schizophrenia and schizophrenia spectrum disorders in the department of assertive (intensive) community treatment. Dissertation. Мoscow Research Institute of Psychiatry under the RF Ministry of Health; 2009.
38. Gurovich IYA, Shmukler AB, Zaytseva YuS. Dinamika neyrokognitivnogo funktsionirovaniya bol'nykh na nachal'nykh etapakh razvitiya shizofreniyi i rasstroystv shizofrenicheskogo spektra. Article in Russian. Zhurn nevrologiyi i psikhiatriiyi, SS Korsakova. 2012;112(8):7–14.
39. Zaitseva YuS. The first psychotic episode: a five-year follow-up clinical neuropsychological study. Dissertation. Мoscow Research Institute of Psychiatry under the RF Ministry of Health; 2010.
40. Magomedova MV, Correlation of social functioning and neurocognitive deficit in patients with schizophrenia and schizoaffective disorder in the early and late stages of the disorder. Dissertation. Мoscow Research Institute of Psychiatry under the RF Ministry of Health; 2003.
41. Shmukler AB, Semenkova EA. Age features of neurocognitive deficit in patients with schizophrenia and schizophrenia spectrum disorders at the initial stages of the disorder. Article in Russian. Social and Clinical Psychiatry. 2013;23(4):19-23.
42. Gurovich IY, Papsuev OO, Shmukler AB, et al. Cognitive bias salience in patients with schizophrenia in relation to social functioning: A four-case observation study. Psych J. 2016;5(1):36-47. doi: 10.1002/pchj.126.
43. Gurovich IYa, Papsuev OO, Minyaicheva MV, Movina LG. Social cognition in schizophrenia and schizophrenia-spectrum disorders. Article in Russian. Doctor.ru. 2014;6-1(84):81-87.
44. Faerden A, Lyngstad SH, Simonsen C, et al. Reliability and validity of the self-report version of the apathy evaluation scale in first-episode Psychosis: Concordance with the clinical version at baseline and 12 months follow-up. Psychiatry Res. 2018;267:140-147. doi: 10.1016/j.psychres.2018.05.065.
45. Mucci A, Vignapiano A, Bitter I, et al. A large European, multicenter, multinational validation study of the Brief Negative Symptom Scale. Eur. Neuropsychopharmacol. 2019;29(8):947-959. doi: 10.1016/j.euroneuro.2019.05.006.
46. Kholmogorova AB, Garanyan NG, Dolnykova AA, Shmukler AB. Cognitive and social skills training (CSST) program for patients with schizophrenia. Social and Clinical Psychiatry. Article in Russian. 2007;17(4):67-77.
47. Semenova ND, Gurovich IYa. The module for the formation of motivation for the rehabilitation in patients with schizophrenia and schizophrenia spectrum disorders. Article in Russian. Social and Clinical Psychiatry. 2014;24(4):31-36.
48. Papsuev OO, Movina LG, Minyaicheva MV. Metacognitive training for patients with schizophrenia and schizophrenic spectrum disorders.Article in Russian. Social and Clinical Psychiatry. 2014;24(3):33-36.
49. Moritz S, Woodward TS. Metacognitive training in schizophrenia: from basic research to knowledge translation and intervention. Curr Opin Psychiatry. 2007;20(6):619-625. doi: 10.1097/YCO.0b013e3282f0b8ed.
50. Zaytseva Y, Garakh Z, Novototsky-Vlasov V, et al. EEG coherence in a mental arithmetic task performance in first episode schizophrenia and schizoaffective disorder. Clin Neurophysiol. 2018;129(11):2315-2324. doi: 10.1016/j.clinph.2018.08.020.
51. Garakh ZV, Zaitseva YS, Novototskii-Vlasov VY, et al. Effects of Instructions on the Early Stages of the Visual Perception of Verbal Stimuli in Health and Schizophrenia. Neuroscience and Behavioral Physiology. 2018;48(4):463-473. doi: 10.1007/s11055-018-0587-3.
52. Murashko AA. Neurophysiological aspects of face perception in patients with schizophrenia spectrum disorders.Article in Russian. Social and Clinical Psychiatry. 2018;28(3):87-91.
53. Spektor VA. Facial affect recognition impairments in schizophrenia and schizoaffective disorder (clinical and neurophysiological aspects): design of the study. Article in Russian. Social and Clinical Psychiatry. 2020;30(2):15-21.
54. Spector VA, Mtskanyan EV, Shmukler AB. P100 and N170 changes in perception of facial expression in patients with schizophrenia and schizoaffective disorder. Article in Russian. Russian Psychiatric Journal. 2020;(6):82-92.
55. Murashko AA, Shmukler A. EEG correlates of face recognition in patients with schizophrenia spectrum disorders: A systematic review. Clin Neurophysiol. 2019;130(6):986-996. doi: 10.1016/j.clinph.2019.03.027.
56. Sukhachevsky IS, Anisimov VN, Latanov AV, Shmukler AB. Oculomotor disorders in patients with schizophrenia. Article in Russian. Social and Clinical Psychiatry. 2018;28(1):83-89.
57. Shmukler AB, Ivashkina AA, Murashko AA. A case of anti-NMDA receptor encephalitis with a clinical picture of febrile catatonia. Bulletin of Siberian Medicine. 2019;18(4):266-272.
58. Murashko AA, Kiryanova EM, Salnikova LI, Spektor VA. Clinical and epidemiological features of psychotic spectrum disorders associated with NMDA receptor antibodies: study protocol. Article in Russian. Social and Clinical Psychiatry. 2020;30(3);37-42.
59. Murashko AA, Pavlov KA, Pavlova OV, Gurina OI, Shmukler A. Antibodies against N-Methyl D-Aspartate Receptor in Psychotic Disorders: A Systematic Review. Neuropsychobiology. 2021:1-18. doi: 10.1159/000515930.
60. Karyakina MV, Shmukler AB. Network analysis as a new research approach in psychiatry. Psychiatry and psychopharmacotherapy. 2020;(5):4-8.
61. Karyakina MV, Shmukler AB. Neurocognitive impairments in patients with schizophrenia and schizophrenia spectrum disorders: cluster analysis results. VM Bekhterev Review of Psychiatry and Medical Psychology. 2020(1):45-51. doi: 10.31363/2313-7053-2020-1-45-51.
62. Shmukler AB, Kostyuk GP, Latanova AV, Sidorova MYu, et al. Network analysis of cognitive, oculomotor and speech indicators in schizophrenia. Article in Russian. S.S. Korsakov Journal of Neurology and Psychiatry. 2020;120(5)-2:54-60.