Psychiatry: A Course of Lectures - V. S. Bitensky 2004

From the history of the development of psychiatry and its methods

History of The Development of the Odesa Psychiatric School and Ukrainian Psychiatry

Until 1922, the Department of Psychiatry—initially at Odesa University and later at the Odesa Medical Institute—was closely intertwined with the Department of Nervous Diseases, sharing joint leadership and a common clinical base for teaching and research.

The first lecturer in psychiatry, serving from 1905 to 1913, was Mykola Mykhailovych Popov, a student of Academician V. M. Bekhterev and the author of the first Bulgarian textbook on psychiatry. He was succeeded by Professor Volodymyr Mykolaiovych Obraztsov, who headed the department from 1913 to 1922.

At that time, psychiatric education was limited to a brief lecture course, occasionally supplemented by patient demonstrations. To give students practical exposure to psychiatric patients, group excursions to the city psychiatric hospital were organized. These studies were further supplemented by Privatdozent courses: "Selected Chapters of Clinical Psychiatry" (by Privatdozent B. I. Vorotynsky) and "Course of Mental Disorders Stemming from General Neuroses" (by Privatdozent V. I. Rudniev).

Professor M. M. Popov’s lectures were immensely popular among students and physicians alike. His course was published as a two-volume textbook: Fundamentals of General Psychopathology (1921) and Fundamentals of Special Psychopathology (1921).

In the 1920s, the departments of neurology and psychiatry were separated. In 1922, the independent Department of Psychiatry was headed by the hospital's chief physician, Professor Anatolii Dmytrovych Kotsovsky, and from 1923 by Professor Yevhen Oleksandrovych Shevaliov, a student of Academician V. M. Bekhterev. Following his mentor's example, Y. O. Shevaliov seamlessly integrated teaching, research, and clinical practice with active public and organizational work. Primarily through his efforts, outpatient services at the psychiatric department were significantly expanded. Consultations with outpatients became a core component of students' practical training in psychiatry. Later, in January 1927, the medical institute's psychiatric clinic was opened, featuring a 50-bed inpatient unit, lecture halls, a museum, laboratories, and study rooms for students. Y. O. Shevaliov played an active role in organizing specialized psychiatric care for patients with neuroses within the newly established psychoneurological dispensary and the Lermontov Sanatorium.

At Y. O. Shevaliov’s initiative, an elective course in psychology was introduced at the department.

In January 1935, a parallel Department of Psychiatry for the Pediatric Faculty was established, headed by Professor Lev Arykovych Myrelzon.

Professor Y. O. Shevaliov mentored a brilliant cohort of disciples who made significant contributions to the advancement of science and clinical practice. Among them were professors L. A. Myrelzon, Ya. M. Kalashnyk, A. M. Khaletsky, O. S. Poznansky, associate professors Ya. M. Kogan, Yu. O. Perelmuter, and assistants O. O. Shyrokov, I. B. Goldshtein, and L. Ya. Sosyura-Velykanova.

The department's primary research focuses included studying the psychopathological Structure of mental disorders, investigating clinical manifestations, and developing Treatment and rehabilitation strategies for patients suffering from borderline neuropsychiatric disorders and Epilepsy.

Among Professor Y. O. Shevaliov’s most significant scholarly contributions are his works: "On Paralogical Thinking", "On Thinking Aloud in Mental Illness", "On Resistance to Psychosis", "On Delayed Reactivity", and others.

During the years of occupation, Y. O. Shevaliov, despite already suffering from failing health, remained in his position as chief physician of the Odesa Regional Psychiatric Hospital. As an educated man fluent in foreign languages, he sought a compromise with the occupation authorities for one sole purpose: to save the lives of the mentally ill. Consequently, the Odesa Regional Psychiatric Hospital became one of the few institutions that, under the occupation regime, not only managed to protect its patients from inhuman extermination, but also saved individuals of Jewish descent from the Holocaust and sheltered underground resistance fighters within its walls. Professor Y. O. Shevaliov’s civic stance serves as an enduring example for future generations of physicians.

Following the liberation of Odesa from the Nazi invaders, active research, pedagogical, and clinical work resumed at the psychiatric clinic. The parallel department of psychiatry was merged with the main department, centralizing psychiatric education for students of all faculties at a single base. In May 1946, Professor Y. O. Shevaliov passed away, and Professor Lev Arykovych Myrelzon was approved as the HEAD of the Department of Psychiatry.

He not only continued the multifaceted work of his mentor but also deepened and expanded the department's research, teaching, and clinical activities. With the active participation of Associate Professor Ya. M. Kogan, long before modern educational and methodological standards were formally introduced in higher education, the department widely implemented METHODOLOGICAL GUIDELINES FOR Practical Classes and developed a system of educational charts. On Professor L. A. Myrelzon's initiative, lectures in medical psychology were resumed. In 1959, the department published a collection titled Issues of Clinical Psychiatry, which explored, among other topics, the pathogenetic mechanisms of obsessive-compulsive states, highlighting The Role of the thalamolimbic-hypothalamic region in switching mechanisms, METABOLISM/18.html">The Influence of interoceptive stimuli on Higher Nervous Activity, and the simultaneous feedback effect of the cortex on the diencephalic region.

The department team, led by Professor L. A. Myrelzon, conducted fruitful research into the Clinical Features of mental disorders arising from closed craniocerebral trauma. Post-traumatic mental disturbances were described across the subacute, late, and remote periods of trauma. Of significant scientific value was the scientist's evaluation of Affective Disorders and his insights into the Pathogenesis of delusions following closed head injuries. Under Professor L. A. Myrelzon's supervision, numerous World War II veterans suffering from the consequences of closed craniocerebral trauma were examined and treated.

Great emphasis was placed on studying the Clinical presentation of Schizophrenia. Interesting data characterizing disorders of higher nervous activity in the schizophrenic process and the psychopathological structure of perceptual disorders were published. L. A. Myrelzon and his colleagues investigated various therapeutic approaches to schizophrenia, particularly its treatment-resistant forms.

Professor L. A. Myrelzon made a substantial contribution to The Study of the clinical aspects of vascular psychoses, especially episodic disturbances of consciousness in Hypertension. He developed crucial diagnostic criteria for psychotic disorders associated with cerebral atherosclerosis and hypertension. Concurrently, the department's staff dedicated significant attention to various aspects of psychiatry, notably involutional and rheumatic psychoses. Department members consistently engaged with the problems of general mental hygiene and psychoprophylaxis, actively promoting a healthy lifestyle.

L. A. Myrelzon trained and mentored many disciples among both department staff and practicing physicians. His academic Lineage includes professors O. M. Kornetov, K. B. Nazarov, O. O. Neduva, associate professors P. G. Nikiforova, V. Ya. Volhin, L. G. Lebedieva, PhDs L. G. Kodynets, Ye. M. Shevalyova, V. G. Poltavsky, L. O. Kharchova, and assistant I. M. Biloziarova. Following Professor L. A. Myrelzon's retirement in 1969, Professor K. V. Moscheti was elected as head of the department, continuing the finest academic and pedagogical traditions of his predecessors. He actively investigated the therapeutic efficacy of biotics (lithium, chromium, cobalt, nickel, etc.). This period in the department's research was characterized by extensive collaboration with leading scientific institutions in Odesa and departments of the medical institute. The longest and most successful scientific partnership was with the Department of Propaedeutics of Internal Diseases, headed by Professor Ts. O. Levina. For 10 years, the therapeutic effects of lithium and cobalt salts on Vascular Diseases were studied, resulting in numerous publications and methodological recommendations.

In addition, K. V. Moscheti served as a scientific supervisor and consultant for numerous postgraduate students and researchers from various clinical departments (therapy, surgery, obstetrics, and gynecology) studying the therapeutic efficacy of biotics. By promoting scientific advancements in BIOLOGICALLY ACTIVE SUBSTANCES, he stimulated the academic thinking of physicians and researchers, encouraged the search for new biologically active natural compounds, the Synthesis of specific medicinal products, and the exploration of new Applications for biotics.

Creatively developing Academician H. I. Markelov’s tenets regarding the hierarchy of regulatory mechanisms in the functioning of the integral Organism in health and disease, the department team conducted research on the pathogenesis and Selection of optimal treatments for epilepsy, schizophrenia, affective psychoses, alcoholism, alcoholic psychoses, and drug addiction. Unique results were achieved in creating an experimental model of catatonic syndrome. Based on these scientific findings, fundamentally new Methods for treating alcoholism and substance abuse were developed.

Beginning in 1976, the department's research interests increasingly focused on the study of alcoholism and drug addiction. Research into the Epidemiology of alcoholism in Southern Ukraine and the clinical features and dynamics of its progression across various occupational groups enabled the DEVELOPMENT OF NEW methods for preventing this disease and its hereditary consequences.

The culmination of the department team's consistent efforts to integrate research initiatives was the establishment in 1983, based at Regional Psychiatric Hospital No. 1, of the "Brain" Scientific, Clinical, and Educational Association. Its creative team included researchers from the Institute of Physics and Chemistry of the Academy of Sciences of Ukraine, the medical institute, and the hospital (which was then headed by V. S. Bitensky).

Based on their research findings, the department team secured 7 patents, 12 rationalization proposals, and prepared and published 3 monographs and 5 sets of methodological recommendations.

Substantial improvements were made to the educational process. The teaching facilities were expanded, and the technical support for instructional activities was upgraded. Technical means for assessing students' knowledge began to be widely implemented.

Postgraduate training and retraining of psychiatrists and narcologists were matters of pressing concern. To enhance the effectiveness of this process, in 1983, on K. V. Moscheti’s initiative, the Department of Child and Adolescent Psychoneurology with Narcology was established within the Faculty of Advanced Medical Training, headed by Professor S. B. Aksentiev.

The clinical Base of the department expanded significantly. Department staff members were assigned to various clinical units to conduct treatment and advisory work. Led by Professor K. V. Moscheti, the department team consistently carried out active educational and outreach work among the population of Odesa and southern Ukraine.

For his outstanding professional and public activities, Professor K. V. Moscheti was awarded the Certificate of Honor of the Presidium of the Supreme Soviet of the Ukrainian SSR, and one of the city's streets is named after him.

The scientist generously shared his scientific ideas and insights with his students, actively supporting them in their creative endeavors and helping them choose their research focus. Under his guidance, several prominent scholars matured professionally: Professor V. S. Bitensky, Associate Professor V. V. Sushko, Candidate of Medical Sciences V. V. Karchevsky, O. M. Mokhovikov, V. M. Karpyak, O. Yu. Donets, O. G. Godlevsky, and Assistant V. D. Vysotsky.

In 1990, Professor K. V. Moscheti stepped down as head of the department, focusing his efforts on research and teaching. Associate Professor V. Ya. Volhin was elected as the new head, under whose leadership research continued to expand, and educational activities grew significantly through the deepening of the medical psychology course and the Introduction of teaching social psychology. The department's educational and methodological work was further improved, with the team preparing and publishing methodological guides for students.

In January 1993, a new merger of the two psychiatry departments took place. Professor V. S. Bitensky was elected as the head of the department. This merger created a unified, consistent, and interconnected system for teaching psychiatry and narcology for students, resident physicians, and clinical trainees. A new research direction—clinical receptorology—was pioneered at the department. The neurochemical mechanisms underlying the pathogenesis of Neuropsychiatric disorders in various mental illnesses are being extensively studied at the neurotransmitter level, resulting in the publication of 4 monographs.

The activities of the "Brain" research association, currently headed by Professor V. S. Bitensky, are continuously improving and developing. The association conducts research on the pathogenetic rationale for developing new psychotropic drugs, as well as their experimental and clinical evaluation.

The department's scientific achievements have been presented at numerous international conferences and congresses across Europe, America, and Asia. Department head Professor V. S. Bitensky was elected a member of the European Psychiatric Association (Strasbourg, 1995), a member of the American Academy of Addiction Psychiatry (Austin, Texas, USA, 1995), and chief expert in psychophysiology at the State Nuclear Regulatory Committee of Ukraine (Kyiv, 1994). He serves on the editorial boards of the journals V. M. Bekhterev Review of Psychiatry and Medical Psychology (Saint Petersburg), Voprosy Narkologii (Moscow), and the Journal of Psychiatry and Medical Psychology (Donetsk).

The department team is characterized by high civic engagement—Professor V. S. Bitensky heads the Odesa Regional Psychiatric Association and the Odesa Regional Committee of the international movement "Physicians for the Prevention of Nuclear War." Since 1999, the department has published two scientific and practical journals: Mental Health Journal (Editor-in-Chief — Honored Worker of Science and Technology of Ukraine, Prof. V. S. Bitensky) and Journal of Psychiatry and Psychopharmacotherapy (Editors-in-Chief — Honored Worker of Science and Technology of Ukraine, Prof. V. S. Bitensky and Acad. S. O. Andronati).

At the initiative of the department, monthly meetings of a Discussion club on pressing issues in modern psychiatry are held, bringing together regional psychiatrists. Since 1999, Odesa has hosted the annual scientific and practical conference "Shevaliov Readings" under the auspices of the department, which has been approved by the Ministry of Health as a nationwide event.

A powerful contribution to the development of world psychiatry was made by leading psychiatrists of Ukraine. Viktor Pavlovych Protopopov (1880–1957), after graduating with honors in 1906 from the Military Medical Academy in St. Petersburg, was appointed by V. M. Bekhterev to the Department of Psychiatry. In 1909, he defended his doctoral dissertation titled "On Combined Motor Reactions to Auditory Stimuli," in which he substantiated a new method for studying conditioned Reflexes in the motor sphere. Investigating somatic features in manic-depressive psychosis, he identified sympathicotonic disorders, which later became known as the Protopopov triad (1920). To treat the manic phase of psychosis, he proposed lumbar novocaine blockade. In 1923, V. P. Protopopov moved to Kharkiv, where he organized the Department of Psychiatry at the Medical Institute, and the Department of Psychiatry and Higher Nervous Activity at the Psychoneurological Institute of Personnel. He was the founder and director of the Ukrainian Research Institute of Clinical Psychiatry and Social Psychohygiene, which was later reorganized into the Psychoneurological Academy. In addition, V. P. Protopopov actively engaged in reorganizing Kharkiv's largest hospital ("Saburova Dacha"). From 1944 until the end of his life, V. P. Protopopov worked in Kyiv, where he established the Department of Psychiatry and Pathology of Higher Nervous Activity within the System of the Academy of Sciences of Ukraine, and was elected an academician. From 1945, he headed the Department of Psychiatry at the Kyiv Institute for Advanced Medical Training.

V. P. Protopopov adhered to two main scientific premises: 1) psychosis is a pathology of higher nervous activity; 2) psychosis is a disorder affecting not only the brain but the entire organism.

He formulated a coherent biochemical Concept of the pathogenesis of schizophrenia. Building on THE CONCEPT OF Nervous system weakness in schizophrenia, V. P. Protopopov developed the principles and methods of protective therapy, and substantiated and introduced Sleep therapy for schizophrenia patients. Based on data regarding the accumulation of toxic Protein metabolism products and somatic disorders in these patients, he proposed a complex of biological therapies for this condition. The scientist made a major contribution to the development of psychiatric care, insisting on the Organization of a psychiatric service in every region. He published nearly 150 scientific papers and mentored 11 Doctors of Sciences and 25 Candidates of Sciences.

Yevhen Oleksiyovych Popov (1899–1961) graduated from the Kharkiv Medical Institute and served as Deputy Director for Research at the Ukrainian Psychoneurological Institute. From 1938, he headed the Department of Psychiatry at the Kharkiv Institute for Advanced Medical Training, and from 1951, the Department of Psychiatry at the First Moscow Medical Institute. From 1946, he was a corresponding member, and from 1957, a full member of the USSR Academy of Medical Sciences. E. O. Popov's major works include Delirium and Insomnia (1934), Materials on the Clinic and Pathogenesis of Hallucinations (1949), and On The problem of the Pathogenesis of Schizophrenia (1957), which demonstrate his broad research interests. The scientist proposed the phase-inhibitory theory of hallucinations, the pharmacodynamic experiment method, and more.

Yakov Pavlovych Frumkin (1902–1978), a student of P. B. Gannushkin, headed the Department of Psychiatry at the O. O. Bohomolets Kyiv Medical Institute from 1932 to 1975. He defended his doctoral dissertation titled "On Types of Epileptic Dementia" (1932). He focused on pressing issues in the theory and practice of clinical psychiatry, the methodology of psychiatric Diagnosis in epilepsy, schizophrenia, infectious pathology, and Mental disorders in the elderly.

Ya. P. Frumkin is the author of over 150 scientific papers in which he was the first to describe such clinical concepts as "unspecified affect type" (in schizophrenia) and the "principle of correspondence." He detailed the Clinical forms of epilepsy and types of epileptic dementia, the clinical presentation of arteriosclerotic hallucinosis, "trace mechanisms in psychopathological symptom formation," "acute psychopathic states," and the "Frumkin triad" (in schizophrenia). He published A number of monographs and textbooks, namely: Psychiatric Terminology (1939); Brief Cytology/practical/136.html">Differential diagnosis OF Certain Forms of Mental Illness (1951); Educational Atlas of Psychiatry (1963) (co-authored with H. L. Voronkov); Psychiatry: Tables and Diagrams (1977) (co-authored with H. L. Voronkov and I. D. Shevchuk); and Trace Effects in the Clinic of Psychopathology (1978) (co-authored with S. M. Livshits). Under Ya. P. Frumkin's supervision, 9 doctoral and 38 candidate dissertations were completed.

Yosyp Adamovych Polishchuk (1907–1978), from 1934 to 1941, combined the duties of a senior researcher at the Ukrainian Research Psychoneurological Institute with those of an assistant at the Department of Kharkiv Medical Institute. From 1944, he worked as an associate professor at the Kyiv Institute for Advanced Medical Training in the Department of Psychiatry. Following V. P. Protopopov's death, Professor Yu. A. Polishchuk headed this department for 24 years. His scientific research focused on the biochemical, immunological, and GENETIC ASPECTS OF the Etiology, pathogenesis, and treatment of schizophrenia and manic-depressive psychosis.

In schizophrenia patients, Yu. A. Polishchuk (1938) discovered protein metabolism disorders leading to gestosis. To eliminate the latter, he proposed detoxification therapy with sodium hyposulfite and unithiol. He was the first (1956) to introduce The concepts of hypoenergism for schizophrenia and hyperenergism for manic-depressive psychosis. He developed the polygenic inheritance hypothesis of schizophrenia. From a biochemical perspective, he described syndromes of endogenous and exogenous intoxication, impaired oxidative processes, alimentary deficiency, and endocrine-autonomic regulation disorders. For each of these syndromes, he also proposed methods for correcting Metabolic Disorders.

The scientist is the author of over 110 scientific works, including 4 monographs: Biochemical Syndromes in Psychiatry (1967), Atlas for Experimental Study of Human Mental Activity (1968), Schizophrenia (1979), and Clinical Genetics in Psychiatry (1981).

Heorhiy Leonidovych Voronkov (1923–1992) was a World War II veteran and participant in the Victory Parade on Red Square in Moscow. In 1953, he graduated from the Kyiv Medical Institute. From 1953 to 1992, he worked at the institute, initially as an assistant, then as an associate professor, and from 1975 to 1991 as Head of the Department of Psychiatry. For 18 years, he served as Chief Psychiatrist and Chairman of the Problem Commission on Psychiatry of the Ministry of Health and the Academy of Medical Sciences. In 1972, he defended his doctoral dissertation titled "On the Problem of Onsets and Early Diagnosis of Epilepsies." He described epilepsy risk factors (epileptic radicals) and a specific form of epilepsy known as cephalgolepsia. His research interests also included Other forms of psychosis, alcoholism, symptomatic mental disorders, and the Organization of Psychiatric care. He authored nearly 100 scientific publications, including Educational Atlas of Psychiatry (co-authored with Ya. P. Frumkin, 1962) and Psychiatry: Tables and Diagrams (1977, co-authored with Ya. P. Frumkin and I. D. Shevchuk). He edited the Handbook of a Psychiatrist (1990). He was a laureate of the Acad. V. P. Protopopov Prize (1990).

The 1950s marked the dawn of the psychopharmacotherapy era, characterized by the widespread introduction of these medications into clinical practice. This was preceded by research into Neurotransmitters in schizophrenia, manic-depressive psychosis, and other mental illnesses. Since then, the clinical presentations of schizophrenia, epilepsy, manic-depressive psychosis, and other mental disorders have evolved—a phenomenon collectively termed pathomorphosis. Research to decode The structure of genes responsible for psychoses began to be actively pursued, which will facilitate the development of new treatments.

In recent decades, alongside the aforementioned classic problems of psychiatry, priority has been given to studying the neuropsychiatric consequences of adverse environmental impacts and reviving person-centered approaches (psychoanalytical, behavioral, etc.), the development of which in our country had been halted back in the 1930s.

Organization of Psychiatric Care

Psychiatry holds a special place among clinical disciplines. Due to its integrative properties and exceptional sensitivity to shifts in historical eras, it simultaneously examines the body, the soul, and the social environment, which influences the psyche in various ways and frequently leads to mental disorders.

However, before reaching its current level, psychiatry traversed a long and complex path. Historians generally distinguish theological, metaphysical, and materialistic periods in the evolution of psychiatry, which to a certain extent reflect the socio-economic development, culture, and ideology of society. Depending on prevailing views and concepts regarding The Nature of mental illness during each period, various treatment methods were applied. Modern treatment methods received scientific substantiation only over the past 30 years, when specialists began widely employing psychopharmacotherapy and social approaches in mainstream psychiatric practice.

Current trends in the development of psychiatry in the civilized world are characterized by a humane and tolerant attitude toward mentally ill patients, and state protection of their legal rights. The organization of psychiatric services involves bringing care as close as possible to patients' places of residence, minimizing their isolation from their families, and fostering a partnership between the patient and the physician. It is also essential to combine the efforts of government agencies and public organizations in providing medical and social assistance to mentally ill individuals and their families.

A special role in the Diagnosis and treatment of patients is assigned to outpatient mental health services. Typically, the majority of patients begin and finish their treatment on an outpatient basis, with only a small fraction (up to 10%) requiring inpatient care. Psychiatric hospitalizations are primarily reserved for patients with severe psychotic disorders.

The core principles of organizing psychiatric care in modern conditions include:

— development of a predominantly outpatient psychiatric network;

— integration of psychiatric and general somatic healthcare services;

— bringing care as close to the patient as possible;

— intensification of treatment using modern pharmacological-biological methods and psychotropic drugs;

— elevating the role of person-centered therapeutic and diagnostic approaches;

— minimizing the isolation of psychiatric patients from their social environment and mitigating the medical and social consequences of mental illness;

— continuity in the activities of the general hospital and psychiatric networks, as well as all other institutions and organizations involved in public mental health;

— widespread Implementation of social forms and methods of patient treatment in psychiatric practice, facilitating the restoration of their social and personal status;

— safeguarding the rights and freedoms of individuals with mental disorders;

— application of psychohygienic and preventive measures. Adherence to these principles makes it possible to create a cohesive system of measures addressing the primary requirements of psychiatric care.

Psychiatric care for patients is provided by inpatient, outpatient, and semi-inpatient (or intermediate) psychiatric facilities. This constitutes a unified complex of psychiatric institutions varying in profile, purpose, and scope of work. These include: psychiatric hospitals, dispensaries (regional, municipal, and district), specialized centers (national, regional, municipal, and district), psychoneurological and psychosomatic departments and offices within multidisciplinary municipal and district hospitals and polyclinics; day hospitals and sheltered workshops attached to psychiatric hospitals, centers, and dispensaries, which serve as an intermediate link in the treatment, diagnostic, and rehabilitation process between inpatient and outpatient psychiatric facilities. In addition, issues related to the psychiatric service are developed in research institutes and departments of psychiatry at higher medical educational institutions.

Inpatient care for psychiatric patients is provided in psychiatric hospitals, centers, inpatient dispensary units, psychoneurological and psychosomatic inpatient departments at regional, municipal, and district hospitals, as well as in psychoneurological boarding facilities within The system of the Ministry of Social Protection and certain other departments.

Depending on the AGE AND SEX of the patients, the course and stages of mental illnesses, the nosological Specificity of mental disorders, and specific tasks and Functions determined by public health authorities, treatment departments are divided into general psychiatric and specialized ones. In turn, they are categorized into facilities for adults and children, men and women, while narrowly specialized units include gerontopsychiatric, somatopsychiatric, epileptological, forensic psychiatric evaluation, compulsory treatment, infectious, tuberculosis, hospital, rehabilitation, psychosomatic units, and others. Furthermore, the profile of a department may be determined by whether pharmacological-biological or social treatment methods are preferred. Typically, wards accommodate patients of the same sex; however, in some clinics, men and women share the same ward. All inpatients, depending on their mental and somatic condition, are prescribed an appropriate regimen alongside pharmacological-biological treatment, namely: restrictive; differential observation; open; semi-inpatient (day hospital) or partial hospitalization.

The regimen is prescribed by a psychiatrist right in the admission ward. Their instructions are mandatory and must be recorded in the medical documentation. Subsequent medical prescriptions depend on the regimen, which is periodically reviewed taking into account the patient's condition. Within the wards, patients are accommodated differentially based on their general and mental condition and the chosen regimen, among other factors. This helps prevent potential incidents during psychomotor agitation or attempts at self-harm or harming others (suicide, aggression, homicide, etc.).

A modern psychiatric hospital should possess not only a robust diagnostic and treatment base, advanced medical technology, and equipment, but also proper living conditions to ensure patient comfort. Traditional psychiatric attributes of the recent past—such as special fixtures, window bars, and locks—should be avoided. The interior layout of premises, particularly wards and treatment-diagnostic rooms, and their furnishing should not differ from those of conventional hospitals. In addition, it is desirable for every psychiatric clinic to feature a club, gymnasiums, sports grounds, tennis courts, a landscaped park, places of worship, a complex of shops and cafes, a consumer service department, etc. Internal regulations for patients and visitors must be grounded in the principles of partnership, mutual assistance, and respect for human rights and freedoms.

An indispensable component of measures aimed at restoring the social status of patients in a psychiatric hospital is The Use of psychotherapeutic interventions and legal services. Efforts should be made to ensure that the average length of inpatient stay does not exceed two weeks. Afterward, patients are discharged home for maintenance therapy on an outpatient basis, semi-inpatient treatment at a mental health center, or day care at their place of residence. Only a few patients require special attention and behavioral monitoring in order to timely implement measures to купирувати (subdue/arrest) acute exacerbations of the illness. Patients with acute psychotic symptoms are predominantly prescribed a restrictive regimen and drug therapy, and they are accommodated in separate rooms under the supervision of medical staff.

In psychiatry, the concepts of emergency and urgent care often overlap and exist largely in a theoretical sense, as it is difficult to predetermine The sequence of actions of a "Psychiatric Emergency" team upon arrival at a call. A psychiatrist's tactics on-site depend primarily on the situation, the patient's specific mental and somatic condition, and their behavior. Immediate psychiatric care is generally required for: patients in a state of psychomotor agitation of various etiologies with impulsive and aggressive actions; those with altered states of consciousness; during acute hallucinations and paranoia; with depression accompanied by fear and suicidal tendencies; and in states of pronounced dysphoria. Such patients receive emergency first aid through the administration of medications (psychopharmacological drugs) that relieve the attack, followed by hospitalization in a psychiatric facility.

Involuntary, or compulsory, hospitalization is carried out—much like emergency psychiatric care—without the consent of the patient or their legal representatives by medical personnel and, if necessary, with the assistance of law enforcement officers. This occurs when there are undeniable signs of a mental disorder that render the patient antisocial, i.e., dangerous to themselves and others. However, the mental disturbance must be unquestionable and confirmed by the patient's actions and statements, i.e., concrete facts. Only this provides grounds for compulsory hospitalization.

Therefore, to execute compulsory actions, primarily in the interests of the mentally ill person, the medical criterion for emergency hospitalization (undeniable mental disorders) must align with the legal and social criteria (danger to oneself or others). It must be emphasized that when deciding on emergency hospitalization, a physician has no room for doubt when evaluating psychotic symptoms and the degree of potential danger posed by the patient. In this regard, it is crucial not to make a mistake. Only real situations, facts, and objectively confirmed threats can serve as the basis for concrete actions by medical staff. Disregarding these rules can result in an unjustified violation of human rights and freedoms, with all the consequent implications for both the patient and those who inadvertently cross the BOUNDARIES OF THE law.

According to current legislation, an individual hospitalized involuntarily without the consent of themselves or their legal representatives (relatives, guardian) must be examined by a commission of three psychiatrists within twenty-four hours. The commission collegially decides on the appropriateness of the patient's continued stay in the psychiatric hospital. If necessary, treatment is extended until the mental condition improves, of which the head physician (head of the department) informs the patient and their relatives. If the patient's mental disorders are minor and do not significantly affect their behavior, the patient does not pose a social danger and categorically refuses treatment, they should be discharged from the hospital under the patronage of a psychiatrist or other medical personnel at their place of residence. Individuals in a state of intoxication or drug-induced intoxication (except for psychotic forms) are not subject to emergency hospitalization in a psychiatric facility.

Worldwide, There is a prevailing trend toward the expansion of outpatient psychiatric care. This corresponds to modern requirements for the Treatment of Mental Disorders. In addition to economic benefits, preserving social status and connections with society—such as family, neighbors, and colleagues—is equally important.

The provision of outpatient psychiatric care is assigned to psychoneurological dispensaries, psychoneurological departments of multidisciplinary hospitals, and polyclinic offices at the patients' place of residence.

In accordance with modern trends, the treatment of psychiatric patients is focused on restoring their personal and social status through rehabilitation measures. Rehabilitation aims at the early and effective treatment of patients, the prevention of their disability, and the timely and effective reintegration of the sick and disabled into society and labor activity. Of great importance is the restoration of social connections lost during the illness. This is made possible through the application of current legislation and the implementation of comprehensive medical, socio-economic, psychological, pedagogical, and legal measures.

International practice distinguishes three stages of rehabilitation: medical, vocational, and social. There are no rigid boundaries between them, but each stage addresses specific tasks with the ultimate goal of restoring the individual and eliminating social maladjustment.

Methods for Examining Patients with Mental and Behavioral Disorders

In psychiatric practice, the following Research Methods play a crucial role:

— clinical and psychopathological method (interviewing, collecting and analyzing subjective Anamnesis data, observing the patient and their behavior);

— Clinical examination of the somatic status;

— clinical examination of the neurological status;

— paraclinical laboratory and instrumental methods (electrophysiological, radiological, including contrast imaging of the vascular bed or CEREBROSPINAL FLUID pathways, and computer Diagnostics);

— experimental psychological and other methods.

Clinical and Psychopathological Examination

The clinical and psychopathological examination is fundamental in psychiatric practice. Its core essence lies in interviewing (conversing with) the patient, gathering subjective (from the patient's words) and objective (from relatives, neighbors, acquaintances, coworkers, documentary evidence, etc.) anamnesis, and observation.

The most common approach when examining a mentally ill person is the interview (conversation). A vast number of mental illness symptoms manifest primarily as subjective disorders that can be uncovered through a skillfully conducted dialogue. This method helps detect most verbal (auditory) hallucinations, delusions, early signs of depressive states, asthenic conditions, phenomena of psychic automatism, obsessive states, and the like.

In some patients who deny having mental disorders, these conditions can only be revealed through a masterfully conducted conversation or targeted questioning. An unskilled interview often fails to uncover depression, delusions, the first signs of psychosis, or suicidal intentions. Consequently, the patient may be left without proper observation, timely medication, prompt hospitalization, or adequate socio-psychological support.

The Patient interview should be conducted calmly and politely, with questions formulated clearly, concisely, and comprehensibly. The patient should be addressed by their full name and patronymic. If the patient shows unsteady attention or restlessness, questions should be repeated several times gently, benevolently, but persistently. If the patient refuses to answer certain questions posed by the physician, it is advisable to temporarily change the topic of conversation. The main objective is not to lose rapport with the patient, as the unresolved question can be revisited later. A skilled interviewer can learn a great deal from a patient even through casual conversation, without forcing them to answer direct questions. This is particularly useful when a person is withdrawn and tries to conceal their illness from the doctor (so-called malingering or concealment of mental illness). Casual conversations allow the physician to assess mood changes, specific perceptions and evaluations of real events, personality traits, and more.

If the physician must ask direct questions (which may not always be pleasant for the patient) to clarify painful experiences, it is essential to listen attentively without missing any details, and, when necessary, ask follow-up questions to thoroughly understand the mental state. To reliably evaluate the information provided, the patient should be asked to give Examples and elaborate on their statements and the circumstances surrounding specific experiences.

Sometimes, the doctor allows patients to describe their illness in their own words as they understand it. In doing so, the physician should skillfully guide the narrative to identify the Specific features of the patient's psychopathological disorders. It should be remembered that patients must be given the opportunity to speak without the presence of their family or acquaintances. As a rule, a sick person feels uncomfortable, embarrassed, or defensive in their presence, making it difficult to obtain meaningful information. One should never agree to converse with a patient "incognito"—hiding one's profession, posing as an acquaintance, an employee of an institution, or a representative of public organizations.

Gathering a subjective anamnesis is inseparable from the interview. At the beginning of the conversation, after inquiring about the patient's well-being, the doctor collects general Background information (full name, age, education, profession, etc.). Next comes the life anamnesis: psychophysical development data, characteristics of educational and work activities, living conditions, family composition, and the nature of relationships within the family, at work, and in social groups. Additionally, it is necessary to determine whether there is a family history of psychiatric, neurological, or somatic conditions, or issues involving alcohol, drug abuse, or smoking. Special attention should be paid to the allergological anamnesis and the patient's tolerance to medications, particularly psychotropic drugs and Antibiotics. The physician should also ask about past illnesses, injuries, and surgeries.

During the questioning, it is essential to carefully analyze the initial signs of mental disorders and, if possible, establish a connection with psychotraumatic situations or prior exogenous injuries (infections, TRAUMATIC BRAIN INJURIES, somatic diseases, intoxications, etc.). Subsequently, one must closely analyze the dynamics of the mental illness, the transformation of Psychopathological Syndromes, and the patient's adaptive reserve capacities. In Addition to a detailed account of episodes (phases, reactions) of the mental illness, It is important to obtain information about The Nature and effectiveness of previous treatments (inpatient or outpatient) and the outcomes of rehabilitation measures.

When gathering subjective anamnesis, one must bear in mind that a patient, under the influence of hallucinatory or delusional experiences, may unintentionally distort life facts or provide entirely false information. This information may sometimes seem plausible, sometimes completely implausible, and in some cases downright unbelievable or fantastic (delusional interpretation of the past, confabulations, etc.). Therefore, one should always strive to obtain objective anamnesis data. Objective anamnesis should ideally be gathered from multiple sources: relatives, neighbors, coworkers, classmates, friends, etc. When questioning relatives (especially parents), the physician should also seek additional information regarding heredity: whether there is a family history of mental illness, intellectual disability, eccentricity, or cases of suicide among relatives. It is also crucial to carefully inquire about the patient's physical and mental development during childhood and adolescence, personality traits, and living and working or studying conditions. Special attention should be paid to the onset of the disease: how initial symptoms developed, how the patient's behavior and working capacity changed, their attitude toward family and others, shifts in life outlook and hobbies, any unusual or strange behavioral acts, and their self-awareness regarding the illness.

When questioning relatives or close friends, one must remember that they may not always provide objective information about their family member and may even deny certain behavioral disorders or interpersonal difficulties. This is often due to a peculiar form of "family defense" of the relative. In such cases, the physician must skillfully structure the conversation with them. Naturally, trust and respect toward the doctor on the part of the relatives will facilitate a more accurate and comprehensive collection of objective anamnesis data.

While interviewing the patient, the doctor should also closely observe their behavior and reactions to various questions and the overall examination context. For the most accurate diagnosis, it is essential to monitor the patient's facial expressions, gaze, voice tone and modulation, and the subtlest changes in their manner of speaking, sitting, moving, and gesturing.

The physician's observations are often supplemented by those of the nursing staff. To this end, ward logs are maintained in departments to describe the patient's behavioral features throughout the day. This enables timely responses to Changes in the patient's mental state.

The features of psychiatric examination outlined above apply not only to the initial contact with the patient but also to monitoring the progression of the disease during treatment. Furthermore, maintaining contact with the patient's relatives throughout treatment is crucial. They can significantly Supplement the doctor's observations at every stage of the illness and be actively involved in rehabilitation measures.

When examining a mentally ill person, accurate description and Classification of their mental state acquire special significance. It should be noted that the data obtained from the examination are recorded in the medical history in a descriptive manner, avoiding psychiatric jargon and premature categorical assessments or interpretations of the psychopathological phenomena observed. It is advisable to depict the clinical picture of the specific individual with all their inherent details.

The presentation of the investigated material follows a specific sequence. As a rule, the Assessment of the patient's mental state begins by stating the features of consciousness (orientation in time, place, situation, and self), the sphere of perception, analytical-synthetic activity, intellectual development, emotional and volitional spheres, memory, temperament, character traits, and overall personality. Naturally, an adequate qualification of the mental state and The ability to objectify the presented facts are the result of extensive clinical experience, knowledge, professional attentiveness, and skill.

Clinical Examination of Somatic Status

It is essential for making an accurate diagnosis and prescribing treatment for a psychiatric patient. During the examination, the doctor should assess the patient's general well-being, working capacity, appetite, sleep patterns, and other vital indicators. Particular attention must be paid to the patient's general appearance, body constitution, and the color of the Skin and mucous membranes. Scars on the head may indicate previous traumatic brain injuries. Skin lesions can be the result of seizures in patients with epilepsy. Tattoos on the body often signify affiliation with antisocial circles, particularly indicating ties to the criminal underworld. Their content and Location on the torso and limbs are crucial for diagnosing deviant behavior. For instance, a cross may indicate a criminal record or a summons before a juvenile affairs commission; a bird with spread wings, a sun with rays, or a broken chain are symbols of a "free life" and defiance. In intravenous drug users, signs of fresh and old injections appear as puncture marks on the skin, especially along the Veins, accompanied by vein hyperpigmentation and sclerosis. In psychopathic individuals, slash marks on the forearms and abdomen may indicate past demonstrative suicide attempts (such multiple superficial cuts are typically uncharacteristic of serious suicidal intent).

General exhaustion is observed in patients with anorexia nervosa, delusional and hallucinatory disorders, and negativism. Overweight individuals are often found to have endocrine gland dysfunction, a history of Insulin therapy, and sometimes neuroleptic treatment.

In accordance with clinical standards, patients should undergo a systematic physical examination (respiratory, cardiovascular, digestive, and excretory systems). In women, attention should be paid to the regularity and duration of menstruation, as well as the CHARACTERISTICS OF THE premenstrual period. Genital anomalies, particularly in adolescents (such as phimosis or cryptorchidism), frequently become a "sore spot" that adolescents tend to keep strictly secret.

In certain mental disorders, women may occasionally exhibit male-pattern Hair growth, facial hair (beard and mustache), and underdeveloped secondary sex characteristics. In men, symptoms may include gynecomastia, short stature, narrow shoulders, and female-pattern hair distribution.

Attention should also be directed to physiological bodily functions—urination (retention, frequent urination) and bowel habits (constipation, frequent bowel movements). These can hold significant diagnostic value (e.g., constipation in depressive states, urinary retention as a side effect of neuroleptics, etc.).

Clinical Examination of the Neurological Status

This holds exceptional importance for psychiatric patients. Neurological evaluation yields a wealth of clinical information, particularly in organic Central nervous system lesions resulting from traumatic brain injuries, neuroinfections, Brain Tumors, and severe intoxications. In such cases, a neurological examination helps determine precisely which parts of The Nervous System are affected and allows clinicians to differentiate between organic lesions and so-called functional Disorders of the central nervous system.

A neurological examination begins the very second the patient steps into the doctor's office. Stiff movements, a lack of associated movements (syncinesia) while walking, and shuffling steps are characteristic of parkinsonism. Ataxic gait patterns may suggest multiple sclerosis, cerebellar disorders, or potentially a frontal lobe tumor. Furthermore, gait disturbances can be of hysterical origin. In such cases, symptoms can be exceptionally diverse and do not resemble any specific type of organic nervous system damage. The patient may make bizarre movements with their legs—dragging them or collapsing to the floor after taking a few steps (astasia-abasia).

During the interview, the patient's facial expression and speech should be carefully evaluated. The doctor notes quiet, monotonous speech, scanned or nasal speech, indistinct articulation (dysarthria), and aphasic disorders.

Special attention is given to the cranial nerve innervation. Pupillary reflexes to light, convergence, and accommodation are tested. Pinpoint pupils are more commonly found in elderly individuals and in certain organic brain structure lesions. Dilated pupils are observed in severe depressive states and poisonings caused by atropine, cocaine, or scopolamine. Sometimes, young women seeking to enhance their appearance wipe their eyes with a cotton ball soaked in an atropine solution, which dilates the pupils and gives the gaze an "enigmatic" look. Asymmetry in pupil size (anisocoria) and irregular inner pupil borders are observed in neurosyphilis and senile dementia. Protrusion of the eyeballs accompanied by widened palpebral fissures is seen in thyrotoxicosis. Exophthalmos can also be caused by an orbital tumor, a brain tumor, or Oculomotor nerve palsy.

A neurological examination includes checking the Symmetry of the nasolabial folds, lateral Tongue deviation, phonation, swallowing, facial pain sensitivity, corneal reflexes, and oral primitive reflexes. Next, tendon and periosteal reflexes of the upper limbs, protective plantar reflexes, and pathological reflexes (Babinski, Rossolimo, Oppenheim, Gordon, Schaefer, etc.) are tested.

It is mandatory to check for signs of meningeal irritation affecting the membranes of the BRAIN AND SPINAL cord (Kernig's and Brudzinski's signs). The state of all sensory modalities—not only on the face but also on the limbs and trunk—is assessed in detail. Balance and coordination of movements are also evaluated.

Paraclinical Laboratory and Instrumental Diagnostic Methods

X-ray Examination

Craniography is the most widespread X-ray method for examining The Skull and brain. Typically, two standard views are taken: anteroposterior (straight) and lateral projections. These projections provide the best visualization with minimal overlapping from the opposite side of the skull. Targeted radiographs are performed to detect changes in the sella turcica. Depending on age, craniograms reveal various signs of elevated intracranial pressure. For instance, in adolescents, signs include spreading of the cranial sutures, deepening and an increased number of digital impressions, enlargement and deepening of the sella turcica, Osteoporosis of its components, and flattening of the skull base. In adults, along with these signs, deepening of the diploic channels, vascular grooves, and venous sinuses is observed.

Skull bone fractures appear on craniograms as fissures or linear fractures, or as depressed/compression comminuted fractures with or without displacement of bone fragments into the cranial cavity. Radiographic signs of a bone fissure include the lightning sign, radiolucency, bifurcation, and marginal defect.

Plain skull radiographs can also reveal calcified tumors, bone resorption (such as bone destruction caused by a tumor), pathological bone proliferation (hyperostosis), and other abnormalities.

Overall, craniography is recommended for diagnosing tumors, gross cerebral atrophy, Blood and cerebrospinal fluid Circulation disorders, as well as metabolic and infectious abnormalities.

Neurophysiological Examination

Neurophysiological methods in psychiatry are objective tools for studying brain activity and its Anatomical and physiological state. The most widespread and diagnostically valuable tests include Electroencephalography, echo-encephaloscopy, and rheoencephalography.

Electroencephalography

Electroencephalography (EEG) is a method for recording the bioelectrical activity of the brain. The Electroencephalogram consists of waves varying in frequency, amplitude, and shape. The Main Components of the EEG are delta waves (frequency of 0.5-3.5 cycles per second — c/s), alpha waves (frequency of 8-13 c/s), and beta waves (frequency of >13 c/s).

The electrical activity pattern of a healthy person's brain depends on age. Over time, there is a progressive acceleration of the dominant electrical rhythm, the formation and stabilization of which are completed by the age of 16-18. In healthy adults, a regular synchronized alpha rhythm (frequency of 9-12 c/s, amplitude of 40-60 µV) is recorded in the occipital cortex in 70% of cases. In the parietal, frontal, and temporal cortical regions, the alpha rhythm is less pronounced than in the occipital area, with beta rhythms and polymorphic activity up to 30 µV predominating. The dominant expression of the alpha rhythm in a healthy person's EEG persists up to the age of 60. During Aging, shifts in the brain's bioelectrical activity occur, characterized by a slowing of frequency, alpha rhythm hypersynchronization, and an increase in slow-wave activity, predominantly of a diffuse nature.

EEG data prove to be most informative in Various Forms of epilepsy, brain tumors, traumatic brain injuries, and inflammatory brain processes.

Thus, in epilepsy, specific encephalographic signs are identified that help refine the diagnosis (spike-wave complexes, slow waves, sharp wave-spikes), and sometimes even determine the seizure type. During the interictal period in epilepsy patients, regardless of seizure type, EEGs typically record paroxysmal activity of various kinds, spikes and sharp waves (sometimes localized, indicating an epileptic focus), spike-wave complexes, and other patterns.

In cases of cerebral hemisphere tumors, 70–80% of EEG recordings show pronounced interhemispheric asymmetry, characterized by a focus of pathological activity in the form of polymorphic delta waves corresponding to the lesion site. In the unaffected hemisphere, changes are either absent or mild. Occasionally, brain tumors present a picture of profound generalized disorganization of biopotentials, frequently accompanied by paroxysmal activity of various types.

Inflammatory Diseases of the Brain and its Meninges typically manifest on the EEG as diffuse changes in biopotentials. In the long-term post-recovery period, the EEG normalizes in the majority of uncomplicated cases. In chronic forms of encephalitis, however, the patient's EEG generally deviates from the norm, showing alpha rhythm reduction, diffuse cortical irritation, and signs of subcortical brain structure irritation.

The severity of EEG abnormalities in patients with psychoses and borderline mental disorders correlates with The complexity of psychopathological syndromes and overall disease severity. Patients with schizophrenia often exhibit a high frequency of low-voltage fast EEG activity. The alpha rhythm displays significant fluctuations in frequency and amplitude, and reactivity may be diminished or distorted. Acute schizophrenic processes are characterized by low-amplitude rhythms, whereas a prolonged, sluggish course reveals a poorly defined alpha rhythm of small amplitude. Depending on the study, abnormal EEGs in schizophrenia are reported in 5–80% of cases. Affective disorders lack any specific EEG changes, and investigations in patients with neurotic disorders likewise reveal no pathognomonic alterations.

Echoencephaloscopy

Echoencephaloscopy (Echo-EG) is a non-contrast method for studying the anatomical relationships of brain structures based on THE PRINCIPLE OF echolocation. It is most widely used to diagnose brain tumors and hematomas, as well as alterations resulting from traumatic brain injuries and disturbances in cerebral hemodynamics and cerebrospinal fluid circulation. Furthermore, Echo-EG makes it possible to detect the presence and severity of CSF hypertension and assess the condition of the brain's ventricular system.

Rheoencephalography

Rheoencephalography (REG) is a method for recording pulsing fluctuations in the electrical impedance of cerebral Blood Vessels. The resulting data provide indirect insight into changes in vascular blood volume, viscoelastic properties, vascular reactivity, elasticity, and tone. This serves as an objective complementary method for investigating cerebral Circulatory Disorders associated with organic brain damage of traumatic or inflammatory origin, as well as vegetative-vascular dystonia, migraines, epilepsy, and cerebral atherosclerosis.

Experimental-Psychological and Other Research Methods

Pathopsychological Assessment

Pathopsychological assessment holds a unique place among paraclinical methods because it is directly aimed at studying human mental activity and personality. By applying specific experimental-psychological techniques, it allows researchers to examine the Internal Structure of cognitive and emotional-volitional processes, identify and classify their impairments, and determine individual characterological and pathacharacterological personality traits.

While these data play an auxiliary role in the clinical diagnostic process, together with patient history, mental status, and laboratory or instrumental findings, they form the foundation for various clinical hypotheses. It would be a mistake to assume that the results of an experimental-psychological evaluation can replace a full clinical examination of a patient's mental state.

The MAIN OBJECTIVES OF an experimental-psychological evaluation are as follows:

1. To obtain pathopsychological data on the characteristics of impaired mental processes in the patient (perception, attention, memory, thinking, speech, intellect, emotional state, and personality traits). In some cases, test results help solve one of the most challenging tasks: identifying the earliest signs of mental dysfunction. For example, using A. Ye. Lichko's pathacharacterological diagnostic questionnaire, the initial signs of a developing personality anomaly can be detected as early as adolescence.

2. To detail the pathological disorders observed in mentally ill patients for differential diagnosis. This approach uncovers characteristic disorders of thinking, emotionality, and volitional activity seen in schizophrenia or epilepsy, helping to distinguish a personality anomaly from a simple form of schizophrenia that may manifest solely as personality changes. It also helps identify memory deficits, cognitive decline, speech disorders, and practical skill impairments typical of organic dementias.

3. To establish the severity of mental deficits, which is particularly crucial for military, forensic, and occupational psychiatric evaluations. The depth of cognitive decline dictates expert decisions regarding criminal offenses committed by a patient. Pathopsychological tests determine the level of intellectual functioning in conscripts reporting for service, and the degree of intellectual-mnestic impairment or emotional-volitional decline determines disability status. Additionally, this type of assessment helps evaluate a child's cognitive performance, enabling medical-educational commissions to decide whether the child should study in a mainstream school or a specialized school for children with developmental delays.

4. To obtain objective data for assessing treatment efficacy and evaluating The impact of specific psychotherapeutic (rehabilitation) methods on the mental disorders observed in patients.

The Clinical-Genealogical Method

Modern principles of clinical and preventive psychiatry emphasize the need to use the clinical-genealogical method alongside clinical and paraclinical approaches. This method involves gathering information regarding the prevalence and clinical manifestations of neuropsychiatric and other pathologies among a patient's relatives.

Based on the results of a clinical-genealogical study, risk groups for developing mental illness can be identified at an early age—primarily in children who have one or both parents with a mental illness. For example, risk factors for schizophrenia include impaired early motor development, decreased activity, motor awkwardness, and schizoid behaviors such as autism, emotional flattening, negativism, and paradoxical excitability. The probability of developing schizophrenia for a child with one affected parent ranges between 10–15%.

The clinical-genealogical method can be valuable in the differential diagnosis of a proband's mental illness, particularly in familial cases of schizophrenia, epilepsy, and oligophrenia.

Diagnostic Laboratory tests in psychiatry are part of a comprehensive somatic (therapeutic, neurological, etc.) evaluation of the patient and are conducted in accordance with standard clinical medicine protocols. However, in psychiatric practice, laboratory findings receive special attention because somatic pathology in mental disorders is frequently atypical or asymptomatic.

Furthermore, somatic disturbances in psychiatric patients can intertwine with existing psychopathological symptoms (such as cenesthesias or hypochondriacal states) and thus go unnoticed.

The Significance of changes detected by various laboratory tests can only be determined through careful correlation with somatic manifestations.