The purpose of the study: to analyze the reforms of the Russian psychiatry beginning in the zemsky period of public administration, to establish the role in these reforms of public psychiatrists, to determine the purpose and objectives of the special direction of scientific and practical psychiatry called «public psychiatry».

Materials and methods: the material for this work was a set of scientific publications on the problems of formation of mental health care in its various historical periods. The analysis of materials is based on the methodology of qualitative research.

Results: the analysis of the evolutionary development of the direction of «Public psychiatry» in the period of Zemsky and Soviet psychiatry, as well as in the post-Soviet period. The assessment of the role of public organizations of users of psychiatric care in the new Russia, which are considered as an important additional link of the state system of psychiatric care.

Conclusion: is supposed important to use the traditions of the zemsky psychiatry for the further development of public psychiatry.

Introduction: the overall global trend is the development of socially oriented psychiatry, which involves the active use of community resources, including the potential of public (non-profit) organizations. The development of social forms of assistance abroad began in the 1960s. In modern Russia the active development of public forms of assistance falls at the end of 80-s of XX century. The regional charitable public organization «Family and Mental health» was established in 2002.

The purpose of the work: to present the basic principles of work, achievements and programs of psychosocial rehabilitation for people with severe mental disorders and their family members, as well as forms of psychological assistance to specialists in psychiatric institutions.

Material: scientific publications devoted to activity of public forms of assistance, results of researches of the Department of Psychiatric Services of the FSBSI «Mental Health Research Centre», as well as the specialists of the RCP0 «Family and Mental Health»; 208 patients participating in the program of psychosocial rehabilitation, elaborated by RCP0 «Family and Mental Health».

Methods: clinical-psychopathological, psychometric (PANSS), statistical.

Results: 15 years experience of the RCP0 «Family and Mental Health» is set out. It is shown that this organization has innovative and reformative potential and its achievements, principles of work, developed programs of psychosocial support confirm that public forms of assistance are an important link in the system of rendering psychiatric assistance, especially in conditions of deinstitutiolization and development of the model of socially-oriented psychiatry.

Conclusions: the experience of the RCPO «Family and Mental Health» can be used by public organizations and psychiatric institutions to improve psychosocial care for patients, members of their families and psychological support of the specialists of psychiatric departments.

Background: the main direction of the psychiatric care organization development is the creation of community-based psychiatry system. The basic principles of community-based psychiatry were formulated in international documents regulating the work and organization of mental health services, and consist in providing comprehensive specialized psychiatric care at the primary health care level integrating psychiatric care into general hospitals, creating rehabilitation and home care services, reduction of the inpatient services, use of evidence-based approaches, continuity between inpatient and outpatient psychiatric services, a multidisciplinary approach and observance of mentally ill people rights.

Aim: description of Moscow Psychiatric Service modernization, produced in 2010-2018.

Material and methods: data of the Psychiatry Organizational and Methodical Department of the Moscow Health Department Order No. 624 of the Moscow Health Department of September, Order No. 753 of the Moscow Health Department and Order No. 130 of the Moscow Health Department.

Results: reorganization of the psychiatric services in Moscow from 2010 have been aimed at optimizing of inpatient and development of outpatient levels. The reform of the psychiatric services was carried out in accordance with the Law of the Russian Federation of 02.07.1992 «On psychiatric care and guarantees of the rights of citizens in its provision» and the principles of community-based psychiatry.

The first stage of reforms, implemented in 2010-2016, consists of the psychoneurological dispensaries joining to the psychiatric hospitals, the inpatient level reduction and reprofiling of psychiatric hospitals. The second stage, implemented in 2017, included the reorganization of psychiatric hospitals: a further inpatient level reduction and the pooling of psychiatric hospitals. The third stage, planned for 2017-2020, involves the development of outpatient facilities.

Conclusions: due to ongoing reforms, the uneven distribution of resources among psychiatric medical organizations in various districts of Moscow has been minimized, the lack of areas for psychiatric outpatient services has been filled, the duration of inpatient treatment has been approximated to the target indications, the structure of the psychiatric outpatient service has been brought into line with the «Order of providing medical care to persons with mental and behavioral disorders».

The review article provides a retrospective analysis of transformation of the psychiatric rehabilitation system in Russia over the last two decades. The experience of international cooperation in the sphere of psychosocial rehabilitation is summarized. Further in the article, the debating points and problems relating to the introduction of psychosocial techniques into the practice of psychiatric institutions in Russia. The article also concentrates on the activity of the Russian National Association of Centers of Psychosocial Work.

Objective: to establish qualitative and quantitative parameters of adaptive-preventive potential of the family for efficient optimization of states and system of relations of patients with schizophrenic disorders in the family and in the society.

Material: cohorts of 51 patients with schizophrenic disorders and 36 first-grade relatives and spouses of patients.

Methods: clinical-genealogical, family-diagnostic with use of questionnaires, tests, scales, projective techniques, statistical.

Results: Scoring of parameters of family functioning, comparison of sociodemographic and psychological characteristics of patients and their relatives allowed distinguishing three levels of adaptive-preventive potential of families of patients with schizophrenia — low, moderate and high.

Conclusions: findings can be a basis for provision of family-oriented psychosocial rehabilitation of patients with schizophrenia spectrum disorders that extends possibilities of prevention in the mental health domain.

Background: the actual scientific and practical task is the introduction into the structure of psychiatric hospitals of new rehabilitation forms of assistance aimed at the development social competence, acquisition skills necessary for an independent life in the society, contributing to their integration into society of patients with long-term mental disorders.

The aim: to present experience of work of the complex modular medical-rehabilitation model within the framework of medical-rehabilitation department with a hostel for rendering assistance to patients with long-term mental disorders and sociopsychological disadaptation.

Material and methods: Cohort of 80 patients who lost social ties with the phenomena of «hospitalism», treated in the St. Petersburg State Medical Psychiatric Hospital № 1 named after P.P. Kashchenko. Clinical and statistical methods were used.

Results: the principles of work of the medical-rehabilitation department with a hostel are developed, its objectives are defined, the complex program of psycho-social rehabilitation is formed, which allows to satisfy most fully the needs of patients with long-term mental disorders in medical and social care.

The conclusion: the medical and rehabilitation department with a hostel is a necessary intermediate medical form between the stationary maintenance of patients and their independent living in the community.

The purpose was to evaluate effectiveness of complex long-term psychosocial rehabilitation program for people with mental disorders which was developed and implemented by regional charity public organization «Family and Mental Health».

Material: the main group consisted of 50 patients with schizophrenia and other schizophrenia spectrum disorders who actively took part in the program. The group of comparison included 106 dispensary patients who did not participate in any of the rehabilitation programs.

Methods: evaluation process was based on clinical-psychopathological inspection as well as psychometric (PANSS, PSP, URICA, SF-36) and statistical methods. The design of the study defined the comparison of the main group characteristics with the dispensary patients. Population characteristics of quality of life (3344 people) and indicators of hardiness of healthy persons (330 people) were used for comparison with the main group.

The results give the evidence that significant differences exist in groups of patients. The participation in rehabilitation program increased the number of compliant patients as well as was identified higher levels of motivation for drug and psychosocial treatment. Also the adaptive of behavioral coping strategies develops in the process of social rehabilitation. There was a statistically reliable decrease in the number of hospitalizations. The received characteristics of quality of life and hardiness of participants of rehabilitation program have allowed to reveal their peculiarities in comparison with healthy persons.

Conclusion: the results of the study showed the effectiveness of complex long-term rehabilitation program developed in the public organization «Family and Mental Health». Public forms of care can be seen as an important part in the overall system of providing psychiatric care to people with chronic mental illnesses.

The aim of the present research was to study neuropsychological features of combined obsessive-compulsive and catatonic disorders in sc hizophrenia spectrum disorders.

Material and methods: 60 patients with obsessive-compulsive and catatonic symptoms were examined. Neuropsychological examination was performed by the use of traditional set of tests (Luria, 1969) [1].

Results: 2 groups of patients with obsessive-compulsive and catatonic symptoms in schizophrenia spectrum disorders are differentiated: 1) OCD with the phenomena of obsessional slowness — obsessive-compulsive and catatonic symptoms develop in the consistent symptom complex; 2) OCD with the phenomena of soft catatonia is an independent manifestation of obsessive-compulsive and catatonic symptoms. The deficit of higher mental functions appeared as difficulties in voluntary regulation of behavior and praxis, intellect dysfunction and a decrease in neurodynamic parameters of mental activity. Severe dysfunction was found in patients with OCD with soft catatonia.

Aim: to perform electron microscopic morphometric study of astrocytic processes (AP), including those directly adjacent to axospinous synapses, in the prefrontal cortex (PFC) and visual cortex (VC) in postmortem brains of schizophrenia patients and normal controls.

Material and methods: PFC and VC (Brodmann areas 10 and 17) obtained from autopsies of 20 cases of schizophrenia and 16 normal controls. Volume fraction (Vv) of APand Vv of mitochondria inside these processes, including those adjacentto axo-spinous synapses, were estimated layers I and II of the PFC and VC in the schizophrenia and control groups.

Results: in layer I of the PFC, a significant decrease in Vv of AP (-31%, p < 0,05), of AP mitochondria (-48%, p < 0,05) and Vv of AP adjacent to axospinous synapses (-44%, p < 0,05) were found in schizophrenia as compared to controls. No significant changes in any of those parameters were detected in the VC of the schizophrenia group compared with control group. In layer II a significantly lower Vv of AP were found only in the VC in schizophrenia (-38%, p < 0,01).

Conclusion: regressive decrease in the Vv of AP in schizophrenia is region-specific and might be associated with the decrease in the density and the dysfunction of axospinous synapses in the PFC. The changes might be of development origin.

Relevance: the deviation from a typical brain lateralization in the audio-speech sphere among patients with endogenous mental disorders is established by numerous of researches. However, the data described in scientific literature are ambiguous. One of methods of definition of a lateralization of audio-speech functions is dichotic listening. This technique is simple in use and is convenient for application both in research, and in clinical practice.

The goal of the study: to identify and describe the peculiarities of audio-speech activity in patients with endogenous diseases by the method of dichotic listening.

Material: three groups of subjects were examined: 33 healthy volunteers, 35 patients with endogenous affective disorders and 54 patients with schizophrenia.

Method: the test of verbal dichotic listening with four-pair presentation of words by special audio material offered D. Kimura and adapted into Russian B.S. Kotik.

Results: it was revealed: 1) more high frequency of dextral asymmetry profiles in the audio-speech activity among patients with endogenous diseases compared to a healthy group; 2) relatively high frequency of bilaterality in the group of healthy subjects and low — among patients, especially with a diagnosis of schizophrenia; 3) high incidence of deviation from the normative values of right ear coefficient in patients with endogenous diseases, and low incidence of deviation in the healthy group; 4) decrease in productivity (mainly due to losing the words directed to the left ear) and the effectiveness in audio-speech activity in patients with endogenous diseases, especially with schizophrenia, compared to healthy subjects; 5) dependence of audio-speech activity on the severity of the mental state: the lowest effectiveness was in patients with severe schizophrenic symptoms that required treatment in hospital.

Conclusions: the study of functional asymmetry and inter-hemispheric connectivity by dichotic listening test is very informative and can be as a basis for a better understanding of the pathogenesis of endogenous diseases, as well as an criterion of their severity and, perhaps, effectiveness of treatment.

Introduction: reorganization of a Moscow psychiatric service is underway. The main object of this renovation is switching from inpatient to outpatient service. Despite the fact, that many researches were made concerning this process, articles focused on an ambulatory psychiatry center are rare.

Objective: to evaluate the efficiency of outpatient departments. To find out the most effective pharmacological ways to deal with patients who often hospitalize to psychiatric hospitals and see whether it is affective to treat them in the outpatient departments.

Material and methods: a statistical and clinical analysis of medical documents of adult patients who received psychiatric help in an outpatient psychiatry clinic and statistic data of the Gannushkins clinic.

Results: the efficiency of an outpatient hospital department and assertive care department was measured. Nosological differences were shown: Patients with schizophrenia (F20.001/2/3) and personality change due to known physiological condition (F00-09) prevailed in the assertive care department. Significantly more patients with neurotic (F40-F48), neurosis-like (F21.3),schizoaffective disorder (F25) and affective (F30-F39) disorders were treated in the outpatient hospital department. Dissimilarities in psychopharmacotherapy were also found, especially significant was the fact that anti-dementia medications were used 3 times more often in the assertive care department.

Result of complex work (medical and psychosocial) were shown. Reduction in the number of hospitalization sin the inpatient hospital hospital and the average duration of treatment there were proved. Also, attention was paid to the group of especially often hospitalized patients, among which 74%suffered from paranoid schizophrenia. The main causes of repeated hospitalizations have been identified: lack of compliance (37%), treatment resistance (30%), alcohol and drug use (22%). It was revealed that patients who used long-acting injectable antipsychotics were hospitalized more often and spent more time in the inpatient department. Those who received mood stabilizers spent less time in the hospital compared with those who did not receive this type of therapy. It is shown that treatment in the outpatient hospital department and assertive care department reduces the frequency and duration of treatment in the inpatient department.

Aim: to present the summary of the results of available Russian studies on the use of hepatotropic infusion drug remaxol in treatment of patients with alcohol dependence.

Method: systematic review.

Results: the positive changes were observed when remaxol was added to combination treatment of acute alcohol intoxication, alcohol withdrawal syndrome and post-withdrawal disorders complicated by hepatic lesions of both alcoholic and non-alcoholic etiology (chronic hepatitis В and C, non-alcoholic steatohepatitis). The use of remaxol results in reduction of incidence of delirium tremens and reduces the duration of the treatment course.

Conclusion: the represented data can be taken as recommendations to be used by physicians in routine clinical practice.