ARCMH | THE CLINIC OF THE FIRST PSYCHOTIC EPISODE

© ARCMH 2008
Address: 31, ARCMH, Talagi, the Primorsky District, the Arkhangelsk Region, 163530 tel./fax: +7 (8182) 66-96-55 E-mail: office@talagi.ru

THE CLINIC OF THE FIRST PSYCHOTIC EPISODE

Since July, 1st, 2005 on the basis of department #8 works Clinic of the first psychotic episode where patients can receive treatment in less stigmatized conditions. The clinic of the first psychotic episode is opened with support of pharmaceutical company Eli Lilly

Department #8 is initially intended for treatment of patients with the boundary mental disorders. Treatment can receive people living in the cities of Arkhangelsks, Severodvinsk, Novodvinsk, Kotlas, Korjazhma, Mirny, and other regions of the Arkhangelsk area.

The following criteria are to be met for patients to be selected for the “first psychotic episode” patient group (Gurovich IY, Shmukker AB, Lubov EB et al., 2003/2004):
- up to three episodes of active-phase symptoms in patients with schizophrenia and disorders of the schizophrenic spectrum, which a total duration not exceeding 5 years
- presence of organized behaviour in spite of the presence of active psychotic symptoms, such as delusions, hallucinations and affective disturbances
- preserved social functioning
- positive attitude towards treatment

Contra-indications are:
- significant acuteness and expressiveness of psychopathological disorder
- socially-dangerous character of psychopathological disorder, antisocial behaviour;
- presence of suicide risk;
- marked conflict mutual relations in the family which promoting, provoking or supporting an worsening of a condition.

If contra-indications revealed patients can temporarily be located in acute psychiatric departments, and after disappearance of acute displays of a psychosis – they can be transferred in clinic of the first psychotic episode.

Tactics of treating of the patients in the department of the first psychotic episode includes a number of the moments:
- As earlier as possible revealing of psychopathological illness and inclusion of patients in the treatment program (reduction of time of "non-treated psychosis ").
- Rendering assistance in least stigmatized conditions (an out-patient mode) on the basis of a principle of partnership with the patient;
- Complex realization of the help by multiprofessional team (with participation of the psychiatrist, the psychologist, the psychotherapist, the expert on social work, nurse).
- Optimum choice of atypical antipsychotic medication.
- Early psychosocial intervention, inclusion of patients and their relatives in psychoeducational programs, realization of training of social skills and neurocognitive training.
- Following-up of the patients during the period of 5 years of illness.

Thus, all patients can be accepted if they do not demand intensive supervision or a confinement to bed and if they keep some level of adequate social activity and work capacity.

Patient can be transferred in acute psychiatric department if his condition gets worse only after commission psychiatric survey at presence of indications for continuation of treatment by way of compulsory hospitalization according to item #29 (“a” and “b”) of the Law of the Russian Federation " About the psychiatric help … ", or on their own will.

Principles of psychopharmacological treatment:
Atypical antipsychotic medications are preferred, because of their positive influence on cognitive functions, and also the better bearableness in comparison with traditional medications and more favorable structure of by-effects that is especially important for patients treated for the first time.

Psychosocial work:
A lot of attention paid on the organization of “the therapeutic environment”:
• the minimal isolation of the patient from a society with preservation of its social communications,
• preparation for conditions of a ordinary life,
• prevention of the phenomena " hospitalizm";
• organization of such atmosphere which encourages useful activity;
• maintenance of useful employment of the patient in view of its specific features and interests;
• Construction of system of self-service.

All patients are involved in labor processes and cultural activities at the department, according to one’s personal features, mental condition, available skills and a labour orientation. Special attention is paying to the organization of leisure time at the department. There is a small library and literary evenings are organized regularly. Patients have an opportunity to play games (checker, chess) - tournaments are arranged. Everyday patients are engaged in gymnastics, during the summer period they can go in for sports in the small park where there are horizontal bars, etc.

Thematic evenings and other cultural-mass actions with dances, games are conducted.

At the department there is a TV and patients who interested can watch telecasts.

Once a week meeting of patients together with medical staff (managing branch, doctors, nurses and other) is held. During this meetings questions, concerning stay at the department can be discussed; patients are acquainted with regulations; doctors and nurses give a talk on various themes (about the reasons and features of mental and boundary disorders, about a healthy way of life, necessity of work therapy, etc.). All new admitted patients are represented to the others, they tell about themselves, their interests.

At the department there are several kinds of group work:
- psychoeducational group for patients with the first psychotic episode (2 times a week),
- psychoeducational group for patients’ relatives (once a week),
- socially-psychological training group (2 times a week),
- neurocognitive training group (2 times a week).

Besides, with a number of patients the individual social work is conducted to decide problems, arising to patients and its relatives in connection with development of disease.

Psychosocial therapy begins on early stage of treatment after improvement of status.

Complex realization of the help:
Treatment is based on the complex approach - unity of psychopharmacotherapy and various methods of psychotherapy and psychosocial rehabilitation. The help is provided by a multiprofessional team including doctor, nurse, psychologist, psychotherapist, social worker.

Nurses and hospital attendants as members of a multiprofessional team take an active part in this work, motivating patients and their relatives on the active attitude to therapy, create the psychotherapeutic environment at the department, support psychotherapeutic community of patients, carry out monitoring results of group and individual forms of work. Besides they help to organize spare time of patients.

The patients who have been discharged from the hospital, continue to be observed in the center of social rehabilitation "Bridge". There the complex of the psychological and social actions aimed to involve former patients in socially useful, creative activity, to help them to adapt in society, to prevent social disorder and socially-dangerous actions is carried out. Also special psychoeducational programs conducted for relatives of discharged patients.

Besides all the patients who received treatment at the department of "first psychotic episode" are observed in out-patient clinic. Local psychiatrist performs correction of medicamentous treatment, traces dynamics of development of diseaseed, in case of deterioration of a condition solves a question on a direction for hospitalization