Vol 2, No 4 (2021)


Diagnosing and Treating Depression and Anxiety in Patients with Cardiovascular Disorders and Diabetes Mellitus in Primary Healthcare: Is Training of Physicians Enough for Improvement?

Karpenko O.A., Melikhov O.G., Tyazhelnikov A.A., Kostyuk G.P.


INTRODUCTION: Common mental disorders — anxiety and depression — are prevalent among patients with cardiovascular disease (CVD) and diabetes mellitus type 2 (DM) and can negatively influence treatment outcomes and healthcare expenses. Despite the importance of management of depression and anxiety in primary care facilities, the diagnostics and treatment of these disorders remain insufficient in the Russian Federation.

AIM: To explore whether the rates of referrals to psychiatrists and indicated pharmacological treatment received due to depression or anxiety among patients with CVD and DM will significantly change in primary healthcare facilities after the training of primary care physicians (PCPhs) to deal with comorbid depression and anxiety (including the algorithm for referral to a psychiatrist).

METHODS: Patients in primary care outpatient settings with diagnoses of CVD and DM passed screening on anxiety and depression using the Hospital Anxiety and Depression Scale (HADS), and information about the indicated treatment for anxiety or depression was collected when present (Sample 1: n=400). The educational programme for PCPhs on the diagnostics of anxiety and depression was then performed, and PCPhs were instructed to refer patients with HADS >7 to a psychiatrist. After the training, the second sample was collected (Sample 2: n=178) using the same assessments as for Sample 1. The independent expert (psychiatrist) evaluated whether the patients had received the indicated pharmacological treatment according to the screening criteria used in the study for anxiety and depression for both samples.

RESULTS: The proportions of patients with borderline abnormal and abnormal HADS scores (>7) were 365 (91.2%) and 164 (92.1%) in Sample 1 and Sample 2, respectively. In Sample 1, among patients with HADS >7, 119 (29.8%) received psychopharmacological treatment, but in only 46 (38.7%) cases was it indicated in compliance with the screening criteria. In Sample 2, among patients with HADS >7, 59 (33.1%) received psychopharmacological treatment, and in only 14 (23.7%) cases was it indicated in compliance with the screening criteria. The differences in the indicated pharmacological treatment were not statistically significant, and no one from Sample 2 with HADS >7 met a psychiatrist through PCPh referral.

CONCLUSIONS: Anxiety and depression are prevalent in patients with CVD and DM treated in primary care facilities, but these patients may not be receiving the indicated pharmacological treatment. Barriers to referral and the use of psychiatric consultation exist despite the focused training of PCPhs and the straightforward referral protocol provided.

Consortium Psychiatricum. 2021;2(4):2-12
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Plasma levels of neurotrophic factors are not associated with the severity of depression

Zorkina Y.A., Syunyakov T.S., Abramova O.V., Yunes R.A., Pavlichenko A.V., Pavlov K.A., Khobta E.B., Susloparova D.A., Tsarapkin G.Y., Andreyuk D.S., Danilenko V.N., Gurina O.I., Morozova A.Y.


Depression is one of the most common mental illnesses. Impaired neurogenesis is observed in depression. Studying the concentration of biochemical indicators in the blood that may be involved in the pathogenesis of depression, looking for associations with the severity of depressive symptoms can be useful as an objective diagnosis of the disease and predicting the severity of the pathology. We determined plasma concentrations of the monoamine neurotransmitters serotonin and dopamine, and neurotrophic factors involved in neurogenesis (BDNF, CDNF and neuropeptide Y) in depressed patients and healthy volunteers with the same socio-demographic parameters using enzyme immunoassay and mass spectrometry. All study participants were administered the Hamilton Depression Scale (HAMD), the Generalized Anxiety Disorder Questionnaire (GAD-7), and the Center for Epidemiological Studies (CES-D). The cumulative scores on the three scales examined were significantly higher in depressed patients than in controls. The concentration of serotonin, dopamine, BDNF, CDNF, and neuropeptide Y in plasma did not differ between the subject groups and was not associated with the scores on the scales. Positive correlations were found between the content of neuropeptide Y and serotonin, BDNF and CDNF in blood plasma. Thus, although these markers are related to the pathophysiology of depression, they do not correlate with the severity of symptomatology and possibly in plasma cannot reflect processes occurring in the brain.

Consortium Psychiatricum. 2021;2(4):13-22
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Stigma and Quality of Life among People Diagnosed with Mental Disorders: a Narrative Review

Ciobanu A.M., Catrinescu L.M., Ivașcu D.M., Niculae C.P., Szalontay A.S.


INTRODUCTION: The anti-psychiatric movements that emerged in the early 1960s led to the appearance of stigma in psychiatry. The misunderstanding of the concept of mental disorder, the negative way in which associated hospitalization was perceived, the inclination to treat patients through psychological therapies, and the criticism of pharmacological treatment led to the discrediting of psychiatry.

AIM: The current paper aims to review the available literature regarding the impact of stigma on the quality of life of people diagnosed with mental disorders.

MATERIAL AND METHODS: A narrative review of relevant literature published between 1999 and 2021 was conducted. The authors analysed studies found on PubMed and the Web of Science electronic databases. The search terms combined two overlapping areas with keywords such as "stigma" and "mental disorders". A descriptive analysis was employed to synthesize the obtained data.

RESULTS: Stigma continues to be an important challenge to the management of health conditions in people with mental disorders. A lack of comprehension may give the impression that all psychiatric patients are aggressive and are unable to function adequately. Such stigmatizing beliefs and habits have proven to be very difficult to change.

CONCLUSIONS: Due to the stigmatization and repulsive attitudes in society, patients are reluctant to be linked to any form of mental disorder or to be seen as having any contact with mental health professionals. This undermines the beneficial effects of treatment, resulting in a poor quality of life and diminished socio-occupational functioning.

Consortium Psychiatricum. 2021;2(4):23-29
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Acceptance and Commitment Therapy for Patients with a First Psychotic Episode

Chernov N.V., Moiseeva T.V., Belyakova M.A., Polyakova M.D., Sozinova M.V.


The search for the most effective methods of therapy for mental disorders is a priority for modern psychiatry. An approach to the early diagnostics and rehabilitation of patients experiencing psychotic episodes for the first time is proposed in the present article. The proposed approach is based on the combination of drug therapy and acceptance and commitment therapy (ACT) characterized by the development of the patient’s psychological flexibility, rather than controlling the disease symptoms. The article describes the main processes of the ACT model: acceptance, cognitive defusion, contact with the present moment, understanding of the inner world, awareness of significant values, and the regulation of purposeful behaviour for the implementation of these values. Recommendations for different stages of treatment were also developed by specialists of the First Psychotic Episode Clinic at the Mental Health Сlinic No.1 named after N.A. Alexeev. The psychological rehabilitation of patients with the use of ACT in the case of psychotic disorders with both negative and positive symptoms was elaborated. The application of acceptance and commitment therapy in the early diagnostics and treatment of patients experiencing a first psychotic episode results in fewer readmissions and improved psychosocial functioning in both inpatient and outpatient care.

Consortium Psychiatricum. 2021;2(4):30-39
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Community-Based Psychiatric Services in Sri Lanka: a Model by WHO in the Making

Rajasuriya M., Hewagama M., Ruwanpriya S., Wijesundara H.


Sri Lanka is a lower middle-income, small island nation in the Indian Ocean, with a multi-ethnic population of 22 million. The healthcare system of the country is well established and relatively advanced, the delivery of which is free to the consumer. The health indicators of the country are impressive compared to regional figures. Psychiatric care in Sri Lanka has witnessed a rapid development over the last four decades, as the care model transformed from an asylum-based model, established during the British colonial times, to a district-wise hospital-based, care delivery model. Gradually, the teams that provided inpatient and outpatient services at the hospitals also started to provide community-based care. The newly added community-based services include outreach clinics, residential intermediate rehabilitation centres, home-based care, community resource/ support centres and telephone help lines. There is no or very little funding dedicated to community-based care services. The teams that deliver community services are funded, mostly indirectly, by the state health authorities. This is so, as these community teams are essentially the same psychiatry teams that are based at the hospitals, which are funded and run by the state health authorities. This lack of separation of the community and hospital teams without separate and dedicated funding is an impediment to service development, which needs to be addressed. However, paradoxically, this also constitutes an advantage, as the provision of care delivery from the hospital to the community is continuous, since the same team provides both hospital- and community-based care. In addition to the essential mental healthcare provision in the community with this basic infrastructure, each community service has improvised and adapted the utilization of other resources available to them, both formally as well as informally, to compensate for their financial and human resource limitations. These other resources are the community officials and the community services of the non-health sectors of the government, mainly the civil administration. Although sustainability may be questionable when services involve informal resources from the non-health sectors, these have so far proven useful and effective in a resource-poor environment, as they bring the community and various sectors together to facilitate services to support their own community.

Consortium Psychiatricum. 2021;2(4):40-52
pages 40-52 views

The Quality of Care Provided by Outpatient Mental Health Services in Georgia

Chkonia E., Geleishvili G., Sharashidze M., Kuratashvili M., Khundadze M., Cheishvili G.


Georgia has recently made a commendable effort to reform mental health care. The “Concept on Mental Health Care” adopted by the Government and the two strategic plans for 2014–2020 and 2021–2031, which aimed to develop comprehensive evidence-based, culturally appropriate, and human rights-oriented mental health care, have promoted the deinstitutionalization and development of community mental health services. Since 2018, new standards of care for mental health ambulatories and mobile teams have been imposed and implemented in the state programme and funded accordingly. The study aimed to investigate the quality of care in community mental health services. As a result, we monitored the mental health ambulatories in all major cities and regional centres of the country (in total, 16 ambulatories) and the mobile teams which had at least two years of experience (in total, 14 mobile teams). The data analyses showed that the new standards for ambulatories and mobile teams increased access to and coverage of mental health care across the country. However, further effort is still needed to achieve comprehensive treatment by mental health care services.

Consortium Psychiatricum. 2021;2(4):54-61
pages 54-61 views

Community Mental Health Services in Greece: Development, Challenges and Future Directions

Anargyros K.P., Lappas A.S., Christodoulou N.G.


The current system of mental health care in Greece was created in accordance with the European Union and other international principles for mental health care provisions. Whereas Greece has been reforming its system of mental health care since at least the 1980s, the main recent Greek effort has been “Psychargos”, a program which began in 2000 and is still in effect. During the last two decades the Greek mental health system has been gradually shifting to a community-based system of care. Various services with unique, yet intertwined, responsibilities have been introduced. The Greek system of mental health care still faces challenges, and the mental health reform is ongoing. Future goals should be to improve the current framework of care and access to care by establishing community mental health services across the country that are fit for purpose, enhancing multidisciplinary collaboration and patient involvement, integrating community mental health care with physical and social care services, and ensuring that service development is driven by need. Crucially, such aims demand the adoption of a culture of clinical governance and a consistent shift from traditional therapeutic care to person-centred psychiatry and preventive psychiatry.

Consortium Psychiatricum. 2021;2(4):62-67
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Grant Support as an Option for the Solution of Specific and Systemic Problems in the Activities of Non-Profit Organizations

Gebel K.M., Geger A.E.


The existing practices for the participation of non-profit organizations (NPOs) in solutions for social policy problems both in the Western world and in Russia are reviewed in this article, and a comparative analysis of the Russian and foreign experiences in this area is performed. A separate section of the article is devoted to studies of the grant support system for non-profit organizations in Russia. Systemic and specific problems are revealed. Conclusions are made on the imperfections of the evolving system for the interaction between the state and non-profit organizations, particularly in the area of project financing, as well as on the necessity for creating the conditions for the distribution of successful “pilot” projects by individual non-profit organizations within the entire territory of Russia.

Consortium Psychiatricum. 2021;2(4):69-76
pages 69-76 views

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