P.8.b.018 Specialised care for patients with mental disorders, associated with somatic pathology under conditions of primary care unit

Abstract

P.8.b.018 Specialised care for patients with mental disorders, associated with somatic pathology under conditions of primary care unit V.F. Lebedeva1 °, E.M. Yurovskaya1, S.N. Maltseva1 1Mental Health Research Institute, Clinics, Tomsk, Russia Purpose: To study the need for differentiated therapeutic and organizational-methodical programmes and extramural forms of mental health care. Materials and Methods: Analyzed material − 2010 people with various levels of mental disorders, associated with somatic pathology. Clinical-psychopathological, clinical-epidemiological, screening-questionnaire, mathematical statistic methods were used. Results: Depending on severity of mental disorders, three groups have been distinguished: group 1 − need for counseling − 4.0 per 1000 of population; group 2 − need for course therapy − 6.8 per 1000 of population; group 3 − need for systematic therapy − 16.2 per 1000 of population. Despite a significant role of psychotherapy and non-drug methods of treatment of mental disorders, in patients of general somatic network, of course, the main place in rehabilitation aspect belongs to psychopharmacotherapy. The most demanded tranquilizers were as follows: Sibazon 10−40mg, Grandaxin (50–100mg), Phenazepam (0.5−1.0mg), Ivadal (5−10mg); antidepressants: amitriptiline (25−75mg), fluoxetine (20−40mg), Anafranil (50–100mg), Ludomil (10−70mg), Lerivon (30–100mg); neuroleptics: Eglonil (50–100mg), Rispolept (4mg). Stimulators of herbal origin, vitamins, and agents improving microcirculation, immunomodulators, vegetative adaptogens, and antioxidants were also used. Biogenic stimulators normalized disturbances of functions of organs and tissues as a result of mechanical damages, dystrophic processes because of infections, intoxications, nervous tension, acute hypoxia and other injuring agents. The following stages of therapy have been distinguished: initial (selection and stopping therapy directed at the stopping the affective saturation of mental pathology and acuteness somatic disorders (vegetovascular, vestibular, algical), basic therapy (purposeful individual differentiated psychopharmacotherapy directed at nosology of mental disorder and symptomtarget) and maintenance therapy (effective medication maintaining the stable mental state). Duration of maintenance therapy constitutes 1 month − for patients with neurotic disorders, 3 months − for patients with organic mental disorders and 6 months − for patients with depressive disorders. Six rehabilitation programmes with their stage-by-stage realization have been developed for patients with neurotic, stress-related and somatoform disorders, organic mental disorders, personality disorders, affective disorders of mood, alcohol dependence, for persons of later age. According to follow-up data (from 2 to 9 years) in group of patients needing course therapy and observation during visits, recovery has been reached in 46.2% of cases, permanent clinical improvement in 65.5%. The differentiated stage-by-stage approach to treatment of combined mental and somatic disorders under conditions of general somatic institution and continuity principle in medical actions have allowed reducing temporary disability in 1.8 times, number of unreasonable visits and examinations per 1 patient in 2.3 times. Conclusions: Thus, use of developed by us preventive and rehabilitation programmes on the basis of somatic policlinic in unity with psychiatric services of mental health facilities has allowed achieving the improvement of quality of life, high clinical and economic efficiency of treatment of patients with combined mental and somatic pathology. P.8.b.019 Prevalence of anti-glutamic acid decarboxylase (anti-GAD) antibodies in psychiatric patients