Vol 1, No 2 (2020)

The syndemic framework goes beyond the concept of comorbidity and considers how diseases interact within their wider environmental context, along with social and political factors, to mutually exacerbate negative outcomes. The syndemic approach enhances the way mental disorders are understood in terms of their aetiology, treatment and prognosis and therefore influences the direction of clinical practice, policy development and research priorities in the field of psychiatry. Using a syndemic framework to develop mental health policy globally can help address the mental health “treatment gap” in countries where resources are limited. In Russia, identified syndemics have been of particular relevance to mental disorders and further research using a syndemic framework will continue to build upon the strong background of integrated mental healthcare currently provided.

Similar to trends in Europe, approaches to mental illness in colonial America and recorded in early United States history were commonly characterized by incarceration and the removal of individuals from communities. In the mid-20^th century, a major shift began in which treatment was offered in the community with the aim of encouraging individuals to rejoin their communities. In this paper, we will provide a brief history of community mental health services in the United States, and the forces which have influenced its development. We will explore the early antecedents of community-based approaches to care, and then detail certain factors that led to legislative, peer and clinical efforts to create ‘Community Mental Health Centers.’ We will then provide an overview of current community mental health practices and evolving challenges through to the present day, including the development of services which remain focused on recovery as the ultimate goal.

Community-based mental health services are important for the treatment and recovery of patients with mental health disorders. The Chinese government has made the establishment of a highly efficient community-based health service an enduring priority. Since the 1960s, community-based mental health services have been developed in many Chinese cities and provinces. National policies, including mental health regulations and five-year national mental health working plans, have been issued to support the development of quality of mental health services. The accessibility and efficiency of community-based mental health services are now highly promoted to community residents.

According to the National Standards for Primary Public Health Services, community-based mental health services are one of the most important components of primary public health services. They are mainly provided via Community Health Service Centres (CHCs), by a combination of general practitioners, public health physicians, nurses and social workers. Patients receive individualized and continuous health services according to their rehabilitation status. These services include regular physical examination, health education, rehabilitation guidance, social function rehabilitation training, vocational training and referral services; family members also receive care and psychological support. Future work will focus on expanding mental health service coverage and usage, increasing awareness of mental health and decreasing stigma, and strengthening service capability to establish an integrated model to enhance the overall efficiency of mental health services.

Depression is the third most common illness among patients with schizophrenia which negatively affects the course of the disease and significantly contributes to the mortality rate, due to increased suicide. Depression, along with negative symptoms and cognitive deficits, is one of the main factors that significantly decreases the quality of life and the disease prognosis in patients with schizophrenia. In addition, depression increases the frequency of exacerbations and readmissions, decreases the quality and duration of remissions and is associated with more frequent substance abuse and an increased economic burden. Data on the prevalence of depression among patients with schizophrenia are contradictory and are associated with a low detection rate of depression in such patients, a lack of clear diagnostic criteria and difficulties in differentiation between extrapyramidal and negative symptoms. The average prevalence of depression that meets the diagnostic criteria of major depressive episodes in patients with schizophrenia is 25% at a specific point, and 60% over the course of a lifetime; the frequency of subsyndromal depression is much higher. It is essential to distinguish between primary (axial syndrome) and secondary depressive symptoms (extrapyramidal symptoms, psychogenic or nosogenic reactions, social factors, etc.) to determine treatment strategies.

The published data relating to randomized clinical trials for the development of evidence-based guidelines are limited. Current recommendations are based mainly on the results of small-scale trials and reviews. Certain atypical antipsychotics (quetiapine, lurasidone, amisulpride, aripiprazole, olanzapine, clozapine) are superior to typical antipsychotics in the reduction of depressive symptoms. Clozapine is effective in the management of patients at risk from suicide. The additional prescription of antidepressants, transcranial magnetic stimulation and electroconvulsive therapy are not always effective and are only possible following the management of acute psychosis in cases when antipsychotic monotherapy proved to be ineffective.

This article discusses case reports of treatment with paliperidone palmitate in comparison with data from recent publications. Second-generation long-acting injectable antipsychotics have been shown to provide better control of psychiatric manifestations, reduce the severity of negative symptoms, improve social functioning and quality of life of patients and relatives, and reduce the burden of disease for both the healthcare system and the caregivers. The case reports presented in this article demonstrate better quality of remission in schizophrenia patients treated with one- monthly and three-monthly paliperidone palmitate formulations, due to higher effi  in preventing relapses, better safety and good tolerability regardless of patient age.

Commentary on the COVID-19 pandemic must necessarily consider the medical issues in social and political context. This paper discusses one important dimension of the context, the long-term history of human activity as intrinsically technological in its nature. The pandemic has accelerated the use of technology to mediate relations between people “at a distance”. This involves not only a change in the skills people have (though acquiring these skills has become the central project of work for many people), but changes the sort of person they are. Our notions of “closeness” and “distance”, or of “touching” and “being touched”, and so on, refer simultaneously to states that are spatial and emotional, factual and evaluative. Inquiry into the differences in human relations where there is physical presence and where there is not raises very significant questions. What are the differences and why are they thought, and felt, to matter? What are the differences when the relationship is supposed to be a therapeutic one? What are the financial and political interests at work in enforcing relations at a distance by new media, i.e., “mediated” relations? How is a person’s agency affected by a lack of freedom to move or a lack of face-to-face contact? What happens to all those human relations for which physical presence was previously the norm, relations such as those performed in the rituals of birth, marriage and death, or in activities like sport and the arts? Can it be said that new technologies involve a “loss of soul”? The present paper seeks to provide a reflective and open-ended framework for asking such questions.

Mental health and psychological education activities are being carried out in Moscow (the Russian Federation), along with measures aimed at prevention of social stigma in mental health care. The medical, social and educational project To Say or Not to Say has been developed by a group of experts from the Mental-health clinic No. 1 named after N.A. Alexeev, for Moscow residents. The title chosen for the project urges participants to make a choice: continue living with their problems or take a step towards solving them. A new educational activity format has been created and tested in the course of the project, and this format provides an opportunity to largely overcome the stigmatizing barriers that prevent people from seeking psychological and psychiatric help in Moscow. Sixteen events involving over 7,000 citizens have been held, and the psychiatrists engaged in the project have spent 2,280 man-hours in this volunteering activity. We believe that this educational activity could help to overcome social stigma in psychiatry, further research is needed to measure the effect of our educational project on social stigma associated with mental health.