© ARCMH 2008-2015
31, ARCMH, Talagi,
the Primorsky District,
the Arkhangelsk Region,
+7 (8182) 66-96-55
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
- preserved social functioning
- positive attitude towards treatment
- significant acuteness and expressiveness of psychopathological
- socially-dangerous character of psychopathological disorder,
- 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
- 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.
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.
A lot of attention paid on the organization of “the
• 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
• 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
At the department there is a TV and patients who interested can watch
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
- 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.
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