[Actual problems of inpatient psychiatric care in Russia].

A comparative evaluation of inpatient psychiatric care in Russia and some other countries is presented. A systematic analysis of the performance of psychiatric hospitals is conducted. The process of the deinstitutionalization in Russian psychiatry is highlighted. A range of problems hindering a reform of inpatient psychiatric service of the country is singled out.

[Effect of social-economic factors on mental health indices in the population of the Russian Federation in 1992-2008: epidemiological models].

Based on system, correlation and regression analyses of official medical and social/economic information over 1992-2008, we developed epidemiological models linking parameters of morbidity and incidence of mental disorders in the Russia Federation with main medical-demographic and social-economic factors. These models may be used for optimal planning of medical/social programs in the field of mental health protection, its operative monitoring and optimal planning of the structure and activity of the Russian system for psychiatric aid.

[Methodological bases for problem solution of monitoring and estimation of mental health services activity: national and international aspects]. / Metodologicheskie osnovy resheniia problem monitoringa i otsenki deiatel'nosti psikhiatricheskikh sluzhb: natsional'nyi i mezhdunarodnyi aspekty.

General principles and questions, concerning the problem of monitoring and evaluation of psychiatric service's work from the points of systemic and mathematic modeling, are considered. An analysis of the structure and parameters values of national psychiatric service is presented. Suggested, are recommendations on using this information and improvement as well its collection, processing and presentation of the results in the national and international aspects. Taking Russia as an example, a selective correlation analysis of the regional rows of the values of the indices for psychiatric service's work was conducted to reveal their informational excessiveness. It is shown that the sets of the indices existed and being elaborated for solution of the monitoring problem and estimation of psychiatric service's work are excessively informative and can not be used without an additional analysis in corresponding mathematic modeling. In the view of the condition of the discussing questions, a use of hierarchical modeling apparatus seems to be the most natural and adequate for the solution of the problems posited.

[The dynamics of the prevalence of mental disorders in the USSR]. / Dinamika rasprostranennosti psikhicheskikh rasstroistv v SSSR.

The two great events took place in the psychiatric life of this country in 1988-1989, namely the implementation of the new law of the conditions and routine of rendering psychiatric assistance to the community and experimentation with changing the principles and routine of the follow-up and registration of persons with mental disorders, carried out in 5 territories of the USSR. Analysis of the 3-year statistical data for the whole country made it possible to ascertain that the years 1988-1989 may be classified as crucial in terms of the changes in conventional approaches to the formation of the patients' groups followed up by the dispensary and as pioneering from the standpoint of distinguishing the patients' groups to be given medical advice. On the whole in 1989, the total number of mental patients treated by the outpatient psychoneurological institutions of this country underwent negligible changes as compared to 1987. At the same time the portion of the patients registered at the dispensaries reduced from 87.7% in 1987 to 82.2% in 1989. On the contrary, the portion of the patients given medical advice increased from 12.3 to 17.8%. Therefore, to trace the dynamics of mental pathology among the population, revealed by the psychiatric services on the basis of the statistical reports, it is necessary to make use of the total data on the groups of patients placed under dispensary observation and given medical advice. To widen the possibilities of rendering assistance to the latter group patients, it is badly needed that the development of the out-of-dispensary forms of rendering psychiatric assistance be intensified.

[The main results of the experiment regarding the changes in the principles of follow-up of patients with mental disorders]. / Osnovnye rezul'taty éksperimenta po izmeneniiu printsipov dinamicheskogo nabliudeniia za litsami s psikhicheskimi rasstroistvami.

In 1988--1989 an organizational experiment was carried out in Moscow, Leningrad, in the Latvian SSR, the Altai territory and in the Ivanovo region. Apart from the conventional follow-up of patients with mental diseases, the counselling form of the follow-up was established in the experimental territories. In accordance with this new principle, the treatment and counselling assistance to persons with mental disorders was rendered only after seeing a doctor. The main results of the experiment are as follows: 1) the follow-up group of patients noticeably diminished at the expense of a decrease of the number of persons taken under the follow-up studies as well as at the expense of more rapid removal of the patients from the register including their active transfer to the patients' group given medical advice; 2) in the follow-up group structure, there was an increase in the number of patients with psychotic disorders and mental retardation and a noticeable lowering of the number of patients with non-psychotic disorders; 3) the group of patients to be given medical advice dramatically increased in the experimental territories, while the number of patients suffering from non-psychotic disorders accounted among them for 80-85%. On the whole the experiment provided evidence in favour of the opportuneness and soundness of introduction into psychiatric practice of the two follow-up types: as far as patients with grave mental disorders and deep social decompensation are concerned, they should be followed up over time by means of conventional methods; as to patients with milder mental disorders, the counselling form of the follow-up is quite sufficient, provided they adapt themselves socially or are well protected (in respect to children and retired persons).