Percentage of the mentally ill in different countries. Which countries have the highest rates of mental illness? Chukotka Autonomous Okrug

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According to the World Health Organization, by 2020, mental disorders will be among the top five diseases leading to disability. In Russia, the situation is complicated by an increase in the number of neurotic disorders associated with alcoholism, poverty and stress at work.

According to studies, every third Russian has a mental or neurotic (depressive) disorder. In recent years, due to mental disorders, the number of disabled people has increased by 13%. These are very alarming figures, since experts suggest that due to the stigmatization of mental disorders in Russia, people seek psychiatric help only in the most extreme cases, and a huge number of patients are left without examination and qualified treatment.

A large role in the denial of a mental disorder in a Russian person is played by his peculiar mentality: it is shameful to be sick, and especially ashamed to be mentally ill. For example, in the United States, approximately one in four residents of the country seeks psychiatric help, and 9.8 million American adults are diagnosed with a psychiatric illness. Such significant figures can be explained by the great popularity of psychological and psychiatric care. “In many countries, first of all, they turn to a primary care doctor. He has the necessary set of knowledge and skills to figure out mental health problems, touch them at least. Our therapists try not to touch this area of ​​activity, ”says the director of the Moscow Research Institute of Psychiatry, Doctor of Medical Sciences Valery Krasnov.

Some disturbing statistics

In Russia, up to 40% of the population have signs of some kind of mental disorder. The share of persons in need of systematic psychiatric care accounts for 3-6% of the population, and the most severe patients make up 0.3-0.6%.

The most common mental disorders are phobias and various obsessive-compulsive disorders, as well as panic and stress disorders. They are considered mild or moderate diseases. According to various estimates, every fourth Russian suffers from them. About 10% of Russians suffer from depressive disorders of varying severity. Various eating disorders (bulimia, anorexia, orthorexia, obesity) occur in 17-21% of the population of our country.

Schizophrenia is considered the most severe among mental illnesses. It affects about 2.3-3.1% of the population of our country. Bipolar affective disorder also belongs to severe mental illness - it affects, depending on the evaluation criteria, up to 7% of the population.

At the same time, Rosstat statistics show that, despite the general increase in the incidence of the Russian population (+ 8% since 2000), in terms of the number of people taken to the dispensary psychiatric register, one gets the impression of a significant, almost twofold, decrease in the incidence of mental disorders (-47% over the same period). period). From 1995 to 2014, the number of people under observation diagnosed with a mental or behavioral disorder decreased by 53% from 93.1 to 44.1 per 100,000 population. Incl. there is a decrease in the number of mental disorders taken under observation for all individual groups of mental disorders (http://www.gks.ru/free_doc/doc_2015/zdrav15.pdf). This curious picture can be explained by several reasons at once:

• changing diagnostic criteria for psychiatric illnesses;
• liberalization of dispensary registration of psychiatric patients;
• change in the structure of morbidity;
• reduction in the availability of medical care and, as a result, the detection of mental illness.

Experts note that the reason for such a bias in statistics (an increase in mental illness with a simultaneous decrease in the number of patients taken under observation), first of all, should be considered a change in the structure of morbidity. Thus, severe forms of mental disorders are replaced by milder ones, with a milder course and less social consequences. The number of persons over 18 years of age with a first-ever established disability due to a mental disorder has also significantly decreased from 4.8 in 2005 to 2.7 in 2014 per 10,000 population, i.e. -43% over 10 years. In addition, the number of people with psychiatric diseases under dispensary registration is noticeably decreasing, along with a significant increase in advisory care. That is, the mentally ill are no longer placed in special medical institutions, and they are treated at home, regularly visiting a doctor to monitor their condition.

Psychiatric care goes further

Paradoxically, at the same time, there has been a decrease in the availability of psychiatric care in our country over the past 20 years. Thus, from 1995 to 2014, the number of psychiatric beds decreased by 22%, in 1995 there were 12.7 of them per 10 thousand of the population, and in 2014 - already 9.8. There is also a lack of specialists. To date, about 16 thousand specialists work in the field of psychiatric and narcological care, including about 4.5 thousand psychotherapists, 5.5 thousand narcologists and 1500 social workers. Psychiatrists for all - no more than 5 thousand. To date, the shortage of psychiatrists in the medical institutions of the country tends to 40-45%.

All these data add up to a rather alarming picture, and the fact that a huge proportion of Russians suffering from mental or neurotic disorders avoid treatment is of particular concern.

Who is to blame and what to do

The situation needs to be changed, says Federation Council Speaker Valentina Matviyenko. It was she who initiated the adoption of a set of measures to urgently prevent the further spread of mental disorders and the adaptation of Russians affected by them. “Because of their illness, these people face misunderstanding and prejudice,” says Valentina Matvienko. “These problems have not yet been given due public and state attention.”

Experts believe that there will be a long work with public opinion, the result of which will be a reduction in the stigmatization of mental illness. In addition, it is necessary to significantly simplify the conditions for patients to contact specialists, including in regions where any medical care may be difficult to access. These measures will help increase the percentage of medical care requests for those patients who are now neglected.

Tatyana Moskalkova, Commissioner for Human Rights in the Russian Federation, pointed out the need to resolve the issue of creating an independent service in Russia to monitor the observance of the rights of patients in psychiatric hospitals. These measures will also help make mental health care more popular in Russia.

In addition, on June 5, 2017, the Scientific and Practical Conference "Regional experience in the modernization of psychiatric services" began in Moscow. The organizers of the conference propose to discuss comprehensive measures to expand the availability of effective psychiatric care to the population, as well as to discuss the reorganization of the psychiatric service in the context of modernizing the healthcare system in the Russian Federation. It is expected that a set of measures will be developed that will improve the deplorable situation in the field of psychiatry that has developed in Russia over the past decades.

The number of people with serious mental illnesses is growing in Russia. Experts cite the fear of seeking help from specialists as one of the reasons. Meanwhile, people have advanced mental illnesses.

The chief psychiatrist of Moscow, Georgy Kostyuk, cites statistics. The average time between the first manifestations of the disease and the first visit to a psychiatrist in Russia is three to five years. All this time, patients either endure in silence, or go to the wrong specialists.

A typical story: a person begins to feel bad. Depressed emotional state, insomnia, psychosis. At first he tries to cope on his own - it does not work. The next possible step is the purchase of sedatives or antidepressants on the advice of a pharmacist or forum members on the Web. Incorrectly selected medicines do not bring relief. The patient decides to see a specialist. Most often it is not a psychiatrist, but a psychologist, whom people consider more “safe”.

“We have an animal fear of psychiatrists in our country. They are treated last. This fear was introduced by the Soviet authorities. Individuals who sought psychiatric help were persecuted. The order of things has changed, but the fear remains.”, - said Lev Perezhogin, a psychiatrist, psychotherapist from the Serbsky Institute.

As a result, the number of mentally ill people in Russia is increasing year by year. According to Georgy Kostyuk, in 1992 the number of mentally disabled people was 370 per 100,000 population, now it is 720 per 100,000 population.

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According to the chief psychotherapist of the Sverdlovsk region Mikhail Pertsel, about 40% of visitors to Russian clinics suffer from depressive disorders. But no more than 10% of people receive adequate psychiatric care. Other common diagnoses of Russians are various neuroses, phobias, schizophrenia.

According to the psychiatrist, head of the Center for Mental Health of the Russian Academy of Medical Sciences Tatyana Krylatova, about 80% of people in Russia need the help of a psychiatrist to one degree or another. But, of course, most of them don't know about it.

“They suffer from so-called borderline disorders from time to time. Subdepressions, manifestations of psychosomatics, anxiety, sleep disturbances. In some people, borderline states turn into mental illness. she sums up.

Psychiatrist Aleksey Magalif doubts the correctness of the statistics voiced by Georgy Kostyuk. According to him, there are no more patients with mental disorders in Russia, their number remains stable. It's just that since 1992, mental illness has become more common, as the quality of medical care has improved.

Psychiatrist Alexander Fedorovich believes that the official number of mental patients in Russia is not true. It increases due to incorrect psychiatric diagnoses by doctors of a different profile. They are guided by the subjective feelings of the patients themselves and enter serious illnesses into the card.

“Somatic doctors “play” psychologists, making “crooked” diagnoses without involving specialized specialists. Such diagnoses are coded by the Bureau of Statistics. For example, a gastroenterologist includes “depression” in the diagnosis, while a cardiologist writes about “neurosis”.” - says Fedorovich.

Narcologist-psychiatrist Sergei Zaitsev agrees with the official statistics. He adheres to the point of view that the number of mentally ill people has increased compared to 1992, because citizens began to drink more.

“In the years after the anti-alcohol campaign, the country was sober, they consumed less alcohol. Many mental disorders manifest themselves when a person either starts drinking himself or his relatives drink. , - says Zaitsev.

It is one of the most serious problems facing all countries, since at least one in four people have such problems at one time or another in their lives. Prevalence rates for mental health disorders in the European Region are very high. According to WHO (2006), of the 870 million people living in the European Region, about 100 million experience anxiety and depression; over 21 million suffer from alcohol use disorders; over 7 million - Alzheimer's disease and other types of dementia; about 4 million - schizophrenia; 4 million with bipolar affective disorder and 4 million with panic disorder.

Mental disorders are the second leading cause of disease burden after cardiovascular disease. They account for 19.5% of all life years lost due to disability (DALYs - years of life lost due to illness and premature death). Depression, the third leading cause, accounts for 6.2% of all DALYs. The share of self-harm, the eleventh leading cause of DALYs, is 2.2%, and Alzheimer's disease and other types of dementia, occupying the fourteenth place in the list of causes, 1.9% of DALYs. As the population ages, the number of people with such disorders is likely to increase.

Mental disorders also account for more than 40% of all chronic diseases. They are a significant reason for the loss of healthy years of life due to disability. The single most important cause is depression. Five of the top fifteen factors influencing the burden of disease are categorized as mental disorders. In many countries, 35-45% of absenteeism is related to mental health problems.

One of the most tragic consequences of mental disorders is suicide. Nine of the ten countries with the highest suicide rates are in the European Region. According to the latest data, about 150,000 people voluntarily die each year, 80% of them men. Suicide is the leading and hidden cause of death among young people, ranking second in the 15-35 age group (after traffic accidents).

V.G. Rothstein et al. in 2001, they proposed to combine all mental disorders into three groups, different in severity, nature and duration of the course, and the risk of relapse.

1. Disorders that force patients to be under the supervision of a psychiatrist throughout their lives: chronically occurring psychoses; paroxysmal psychoses with frequent attacks and a tendency to transition into a continuous course: chronic non-psychotic conditions (sluggish schizophrenia and conditions close to it, diagnosed as “schizotypal disorder” or “mature personality disorder” within the ICD-10) without a tendency to stabilize the process with a satisfactory social adaptation; states of dementia; moderate and severe variants of mental retardation.
2. Disorders requiring observation in the active period of the disease; paroxysmal psychosis with the formation of long-term remission; chronic non-psychotic states (sluggish schizophrenia, psychopathy) with a tendency to stabilize the process with satisfactory social adaptation; relatively mild variants of oligophrenia; neurotic and somatoform disorders; mild affective disorders (cyclothymia, dysthymia); AKP.
3. Disorders requiring observation only in the period of an acute condition: acute exogenous (including psychogenic) psychoses, reactions and adaptation disorders.

Having determined the contingent of patients in need of psychiatric care, V.G. Rothstein et al. (2001) found that about 14% of the country's population needed real mental health care. While, according to official statistics, only 2.5% receive this assistance. In this regard, an important task for the organization of psychiatric care is to determine the structure of care. It should have reliable data on the true number of people in need of psychiatric care, on the socio-demographic and clinical-epidemiological structure of these contingents, giving an idea of ​​the types and volumes of assistance.

The number of patients in need of help is a new indicator, "the current number of mentally ill." The definition of this indicator should be the first task of an applied epidemiological study aimed at improving mental health care. The second task is to obtain a basis for improving diagnostic and treatment programs, planning the development of psychiatric services, calculating the necessary personnel, funds and other resources on the basis of the “actual number of mentally ill”, as well as on the basis of a study of the clinical structure of the corresponding contingent.

When trying to estimate the "actual number of patients" in the population, it is necessary to decide which of the commonly used indicators is most adequate. The choice of one indicator for all mental health disorders is inappropriate. For each group of disorders, combining cases that are similar in severity, nature of the course and the risk of relapse, a different indicator should be used.

Taking into account the characteristics of the selected groups, indicators are proposed to determine the “actual number of people with mental disorders”; life prevalence, year prevalence, point prevalence, reflecting the number of people suffering from this disorder at the time of the survey.

• For patients of the first group, life prevalence reflects the number of people who have experienced this disorder at any time during their lives.
• For patients in the third group, year prevalence reproduces the number of individuals in whom the disorder was noted during the last year.
• For patients of the second group of disorders, the choice of an adequate indicator is less obvious. Prytovoi E.B. et al. (1991) conducted a study of patients with schizophrenia, which made it possible to determine the period of time after which the risk of a new attack of the disease becomes the same as the risk of a new case of the disease. Theoretically, it is this period that determines the duration of the active period of the disease. For practical purposes, this period is prohibitively long (it is 25-30 years). At present, active dispensary observation is stopped if the duration of remission in paroxysmal schizophrenia is 5 years. Given the above, as well as the experience of psychiatric institutions in the duration of observation of patients with other (non-schizophrenic) disorders included in the second group, one can choose as a satisfactory indicator for it the prevalence over the past 10 years (10-year prevalence).

To estimate the actual number of persons with mental disorders, an adequate estimate of the total number of persons with mental health disorders in the population was needed. Such studies have led to two main results.

• It has been proven that the number of patients in the population is many times greater than the number of patients in psychiatric services.
• It has been established that no surveys can identify all patients in the country, so the full number can only be obtained through a theoretical assessment. The material for this is the data of current statistics, the results of specific epidemiological studies, etc.

The prevalence of mental illness in Russia

Analyzing WHO materials, national statistical and clinical and epidemiological materials, O.I. Shchepin in 1998 identified trends and patterns in the spread of mental illness in the Russian Federation.

• The first (main) regularity is that the rates of prevalence in Russia of all mental illnesses over the past 45 years have grown 10 times.
• The second pattern is a relatively low level and slight increase in the prevalence of psychoses (mental or psychotic disorders proper: an increase of only 3.8 times over the entire 20th century, or from 7.4 cases per 1 thousand people in 1900-1929 to 28, 3 in 1970-1995). The highest prevalence rates and growth rates are characteristic of neurosis (increased by 61.7 times, or from 2.4 to 148.1 cases per 1,000 people) and alcoholism (increased by 58.2 times, or from 0.6 to 34.9 cases per 1 thousand people).
• The third regularity is the high rates of growth in the prevalence of mental underdevelopment (30 times, or from 0.9 to 27 cases per 1 thousand people) and senile psychosis (20 times, or from 0.4 to 7.9-8 cases) .
• The fourth regularity - the greatest increase in the prevalence of mental pathology was noted in 1956-1969. For example: 1900-1929 - 30.4 cases per 1 thousand people. 1930-1940 - 42.1 cases; 1941-1955 - 66.2 cases; 1956-1969 - 108.7 cases and 1970-1995 - 305.1 cases.
• The fifth pattern is actually the same level of prevalence of mental illness both in the economically developed countries of the West and in the Union of Soviet Socialist Republics (7.2 and 8 times growth in 1930-1995). This pattern reflects the universal essence of mental pathology, regardless of the socio-political structure of society.

The main reasons for the increase in the number of mental disorders in the modern world, according to WHO experts, are an increase in population density, urbanization, destruction of the natural environment, the complication of production and educational technologies, an avalanche-like increase in information pressure, and an increase in the frequency of emergency situations (ES). deterioration in physical health. including reproductive, an increase in the number of brain injuries and birth injuries, intensive aging of the population.

The above reasons are fully relevant for Russia. The crisis state of society, abrupt economic changes with a decrease in the standard of living of people, a change in values ​​and ideological ideas, interethnic conflicts, natural and man-made disasters that cause population migration, the breaking of life stereotypes significantly affect the mental state of members of society, give rise to stress, frustration, anxiety, feelings of insecurity, depression.

Closely related to these are socio-cultural trends affecting mental health, such as:

• weakening family and neighborly ties and mutual assistance;
• a sense of alienation from state power and the system of government;
• the increasing material needs of a consumer-minded society;
• spread of sexual freedom;
• rapid increase in social and geographic mobility.

Mental health is one of the parameters of the state of the population. It is generally accepted to assess the state of mental health in terms of indicators characterizing the prevalence of mental disorders. Our analysis of some socially significant indicators made it possible to identify a number of features of their dynamics (according to data on the number of patients who applied to out-of-hospital institutions of the psychiatric service of the Russian Federation in 1995-2005).

• According to statistical reports of medical institutions of the Russian Federation, the total number of patients who applied for psychiatric help increased from 3.7 to 4.2 million people (by 13.8%); the overall incidence of mental disorders increased from 2502.3 to 2967.5 per 100 thousand people (by 18.6%). Approximately in the same proportions, the number of patients who were diagnosed with a mental disorder for the first time in their lives increased: from 491.5 to 552.8 thousand people (by 12.5%). The primary incidence rate increased over 10 years from 331.3 to 388.4 per 100,000 population (by 17.2%).
• At the same time, there were quite significant shifts in the structure of patients according to individual social characteristics. Thus, the number of people of working age with mental disorders increased from 1.8 to 2.2 million people (by 22.8%), and per 100 thousand people the number of such patients increased from 1209.2 to 1546.8 (by 27.9%). In the same period, however, the absolute number of working mental patients decreased from 884.7 to 763.0 thousand people (by 13.7%), and the indicator of the number of working mental patients decreased from 596.6 to 536.1 per 100 thousand population (by 10.1%).
• The contingent of patients with mental disabilities increased quite significantly over the specified period: from 725.0 to 989.4 thousand people (by 36.5%), i.e. in 2005, in the contingent of all patients, almost one in four was mentally disabled. Per 100,000 people, the number of disabled people increased from 488.9 to 695.1 (by 42.2%). At the same time, the decrease in the indicator of primary disability due to mental illness, which began in 1999, was interrupted in 2005, it began to increase again and in 2005 amounted to 38.4 per 100 thousand people. The share of working disabled people fell from 6.1% to 4.1%. The proportion of children in the total number of mentally ill people recognized as disabled for the first time in their lives increased from 25.5% to 28.4%.
• With a fairly moderate increase in the total number of mentally ill patients, the contingent of hospitalizations has slightly increased. In absolute terms: from 659.9 to 664.4 thousand people (by 0.7%), and per 100 thousand of the population - from 444.7 to 466.8 (by 5.0%). At the same time, the increase in the number of hospitalized patients occurred exclusively at the expense of patients with non-psychotic mental disorders.
• The number of mentally ill people committing socially dangerous acts increased: from 31,065 in 1995 to 42,450 in 2005 (by 36.6%).

Thus, in 1995-2005, with a moderate increase in the total number of patients with mental disorders who applied for specialized assistance, there was a "weighting" of the contingent of patients: both due to a significant increase in the number of patients with mental disabilities, and due to a significant reduction in the number of employees mentally ill.

According to the World Health Organization, there are now about 450 million people in the world with disorders and mental disorders. According to experts, the number of people suffering from dementia in the coming years will grow at an unprecedented pace.

According to forecasts, over 35 million people will need medical help next year due to the development of degenerative brain diseases. And that number is expected to double every 20 years. Therefore, by 2030 the number of such patients may reach 65.7 million, and in 2050 - 115.4 million people.

Only a small proportion of this mass of people will receive the necessary treatment.

The rise in mental illness will be most acute in the coming years in low- and middle-income countries. This is explained by the lack of qualified medical personnel and specialized clinics.

Bagnet decided to check whether the world statistics are fair for Ukraine and whether the number of mental patients is growing in our country.

In the main psycho-neurological clinic of the country - the capital's hospital. Pavlov - they said that in Ukraine the number of mentally ill people has remained at the same level for a long time. This is approximately 1 million 200 thousand people.

“Surprisingly, with the onset of the global crisis, 5-7% fewer patients are admitted to hospitals for treatment than in previous years. Although, it would seem, according to logic, everything should be the other way around. We expect fewer and fewer people to be treated in hospitals in the future. And the majority of patients with mental disorders lives and will live in the "ordinary world". This contributes to their speedy recovery, ”Mikhail Ignatov, deputy chief physician of the Kyiv City Psychoneurological Hospital No. 1, explained to Bagnet.

According to him, official WHO data on the number of mental patients who live on the planet are underestimated.

“In fact, the number of people who suffer from certain mental disorders is 10% of the total population of the earth. This is much more official data. It's just that many chronically ill people are unaware of their illnesses, do not want to be treated, etc.,” Ignatov believes.

Employees of regional psychiatric hospitals were reluctant to make contact. For example, in the Kharkiv and Zhytomyr regional clinical psychiatric hospitals, the Bagnet correspondent was told that it was not customary for them to give comments and interviews to the press.

In the Transcarpathian Regional Psychiatric Hospital, Ignatov's information was confirmed - the number of patients remains at a "stable" level. About 3,000 patients are admitted to the local hospital every year for treatment. In general, about 33 thousand citizens suffering from mental disorders are permanently registered.

The chief physician of the Crimean Republican Clinical Psychiatric Hospital No. 1, Mikhail Yuryev, said that the number of patients in Crimea was “usual” and that he had not heard anything about an increase in the number of crazy people.

To all further clarifying questions, Mr. Yuryev answered with awkward discussions about Honduras, apparently close to him by virtue of his profession.

The interview had to be terminated.

Arkady Shmilovich - Head of the Medical and Rehabilitation Department of the Clinical Hospital No. N.A. Alekseeva, President of the Regional Public Organization "Psychiatrists Club", Candidate of Medical Sciences and laureate of the Moscow Government Prize in the field of medicine.

- How many people in Russia and in the world suffer from mental disorders?

According to the statistics of the World Health Organization, now every tenth person on Earth suffers from serious mental disorders that require psychiatric help. And the same number, that is, every tenth, has borderline disorders. These are serious statistics, but I do not exclude that there are much more such people. Both in Russia and in other countries, studies were conducted, during which it turned out that about 60% of people who go to a regular clinic need the help of a psychiatrist to one degree or another.

It is known that in Russia every year more than seven million people officially seek psychiatric help. But this, from my point of view, is a greatly reduced figure, because many do it unofficially. People are afraid of psychiatric records, which in fact have not existed for 25 years.

- Then what certificates from a neuropsychiatric dispensary are sometimes required when applying for a job? I would like to understand whether it is necessary to be afraid of problems with further employment when you go to a psychiatrist?

- If someone from the personnel department requires you to bring a certificate of whether you are being observed at the dispensary, then he is seriously violating the law. In any Western country, in response to such a demand, an employee of the personnel department will be called to court. But it happens that when applying for a job in a number of institutions, they require a certificate stating whether you can perform this or that job due to your mental state. The difference is that a person can be observed in a dispensary, including with a serious illness, but it proceeds in such a way that it does not interfere with doing one or another job. Then the person is given the appropriate certificate. Many people - including personnel workers - think that this is a certificate of whether a person is being observed at all.

Where does mental illness come from?

- This is the main question of psychiatry. If we knew exactly the answer to it, we would practically solve the problem of mental health. First, mental illness itself affects the personal sphere of a person, that is, our entire existence. There are many conflicting theories. Many mental disorders are associated with external conditions, they depend on the degree of tolerance of a person to environmental influences. If we talk about some internal processes, for example, biochemistry and metabolic disorders, they are detected by research, but it is difficult to say whether they are the cause of mental illness or a consequence. To date, the opinions of scientists regarding the problem of the causes of mental illness are leaning towards all sorts of genetic damage that exists in the body. These genetic breakdowns are not fatal, they may not necessarily give rise to the development of a particular disease, but they are a predisposition to its onset. Various disturbances in the biochemistry and physiology of the activity of the brain, the transmission of various impulses between nerve cells are also found. At this stage, it is difficult to say which disorders are associated with certain diseases.

- There is a feeling that recently there have been more people with mental disorders. Is this really true or is it just being talked about more often?

- On the one hand, they began to speak more often, including objectively - this is a good trend. But at the same time, there were actually more mental disorders. Disorders can be divided into several categories. There are so-called endogenous mental disorders - their causes are associated with internal pathogenic factors, the nature of which we do not always know clearly. They don't become anymore. For example, according to various sources, the possibility of getting schizophrenia is 0.85-1.2% - this is one person out of a hundred. But there are disorders associated with the environment - at school, university, family, country. Any cataclysms, crises, uncertainty about the future, stress, fears of terrorist acts breed mental disorders. Sometimes they are, as it were, on the periphery of your consciousness or your life, so they can appear and go away, they can return - then we are dealing with borderline disorders. These disorders are certainly on the rise as life gets more stressful. The problem lies in the insufficiency of our, psychiatrists, work in terms of psychohygiene and psychoprophylaxis. Of course, doctors cannot change everything, but they must be more active: it is important to prevent the disease, we often forget primary prevention. And it could seriously improve the situation with the prevalence of borderline disorders.

- Is it possible to say that in big cities people get sick more often?

- Of course, urbanization plays a huge role. In a big city there are many problems and temptations, a high pace of life. We should not forget about the narcological problem - psychoactive substances are more often abused in the city. Although in the village often no one pays attention to people suffering from mental disorders: he lives for himself and lives, communicates, marries, gives birth to children. The city is more active in showing even minor symptoms of the disease. Personally, I am completely tolerant of what is called mental disorders. I really like people who have some features of their mental development: in the end, we are all interested in these features.

Is it possible to derive rules that would help maintain mental health: healthy lifestyle, diet, sports? In general, what can help not get sick?

Of course, the lifestyle should basically be tonic in nature - sports, an active lifestyle, but taking into account personal characteristics. It is important not to abuse anything, to load your brain with intellectual work at all stages of life, to be versatile, to be interested in everything that is possible, not to narrow your life to some separate interests - even in science, you need to leave room for creativity. We must teach ourselves to see the interesting, to strive to be witty. Better not to be specific at all, not to be a bore. It is very important to build a tolerant attitude towards others. It is from conflicts that borderline disorders often grow, so a lot depends on how you get out of disputes. First of all, you need to pay attention to yourself, and then try to make a correction in the behavior of your opponent. One must be merciful, but not demonstratively show sympathy, but try to help a person realize his aspirations, not pass by and not be indifferent. All this creates a favorable atmosphere, which turns into a therapeutic environment, where nothing hurts others, where there is mutual respect and mutual assistance, where your existence already provides support to someone. We strive to create such an environment in departments where sometimes very difficult patients lie, and this helps them quickly recover from acute conditions.

- What is psychosomatics? Does she really work?

- Health is a complex concept. It cannot be considered that there is a separate mental, gynecological or pulmonological health. At the head of everything is the brain, which regulates, although we still do not fully know how, the activity of the whole organism. Much depends on the mental organization of a person, and sometimes a psychiatrist with his participation can significantly increase the effectiveness of the treatment of many diseases that, at first glance, are not related to psychiatry. This is a whole field in healthcare called psychosomatic medicine. For example, many skin diseases, hypertension, duodenal ulcer, various disorders in the activity of the gastrointestinal tract, and bronchial asthma are considered psychosomatic disorders. Sometimes a child is diagnosed with asthmatic bronchitis, and when we begin to deal with it, it turns out that there are constant quarrels and screams in the family: the child lives in this unfavorable environment and suddenly begins to suffocate, he has all kinds of fears, phobias. A competent psychotherapist or psychiatrist, who begins to work with a child and engages in changing the situation in the environment, achieves an effect. Sometimes just a consultation is important.

- How to find a good psychiatrist - one who could understand both personality traits and somatic subtleties?

- Have to search. Sometimes in a not very well-known ordinary hospital, a doctor suddenly appears, from whom all patients are crazy, because he provides effective help. In psychiatry, there are very often doctors without regalia, who at the same time master psychotherapeutic techniques and understand that not only medicine is an effective help. The problem of modern psychiatry is that the drug approach has again prevailed, medical care has become one-sidedly biological. In the 50s, the development of psychopharmacology began - and all psychiatrists were delighted, because it turned out to be possible with the help of a drug to relieve the most acute mental disorders that had not been relieved for years. Then we thought that we had overcome the disease and now it would be possible to treat patients at home. But very little time passed - and we saw that psychopharmacotherapy leads to less deep remissions than some previous methods, sometimes patients develop resistance to the drug when it stops working. And again, the relevance of the rehabilitation direction has increased, when a medicine is a tool that allows you to open a patient to work with him. Mental disorder affects the personality, and personality manifests itself in many areas of life. Most importantly, although we cannot completely cure the patient, we can teach him to live with the disease. We need to look for doctors focused on this.

How exactly should the treatment take place? What place should be given to drugs, and what - to rehabilitation?

- All mental illnesses are manifested by various disorders. There are so-called productive disorders, to which we can include hallucinations, manias, delusions, and various obsessions. These disorders, if they reach a psychotic level, require drug treatment. But, unfortunately, mental illness often leads to specific changes in the personality of patients in the emotional, volitional, mental spheres. Medications do not by themselves lead to a marked improvement in these symptoms, which are called negative. Here we should talk about a different approach, which is based on the rehabilitation ideology. This is a combination of drug therapy with psychosocial methods, psychotherapeutic effects, psychological correction. It is also an appeal to the inner depths of the personality and to those possibilities of creative self-expression that are present in every person. By opening these possibilities, we influence the personality. There are a lot of examples when people who suffered from severe mental illness with pronounced personality changes, through their creative abilities, became idols of generations. Therefore, in general, we should not talk about drug therapy, but about a comprehensive rehabilitation approach, where drug therapy opens a person to work with him. If we are dealing with a drug-only approach, we get poor mental health care and a high level of disability.

- Is the risk group for mental illness determined? Is it possible to understand by gender, age or place of residence, is there a chance of getting sick?

- Children's disability is growing now, if we mean mental disorders. This is due to many factors: alcoholism and drug addiction of parents, early development, various temptations, substance abuse - many Moscow children have contact with them at school, albeit episodic. The fact that disability continues to grow indicates a lack of attention to mental hygiene and prevention. In general, the risk group includes those people who are in an unfavorable environment, but it is difficult to define this group specifically.

Today, about 25,000 people a year commit suicide. Although we have, of course, improved this situation - just 10 years ago, about 60 thousand people annually committed completed suicide

Depression is the current disorder. It may be a situational symptom, or it may be the onset of depression as a mental illness, in which case it suggests a high risk of suicide. Today in Russia, about 25,000 people a year commit suicide. Although, of course, we have improved this situation - just 10 years ago, about 60 thousand people annually committed completed suicide. Here we must remember that if within two weeks the mood is lowered, there is depression, especially if this depression is in the nature of melancholy and depression, and there are no special reasons for this, this is a reason to go to a psychiatrist - specifically to a psychiatrist, and not to psychologist. And the psychiatrist, having understood, will be able to say what kind of help is needed.

- What other symptoms should seem alarming? When should you go to a psychiatrist?

- Symptoms of the sea - depending on what kind of disease in question. There are symptoms of a neurotic level that appear under adverse external circumstances related to work, family life, relationships, tragedies. They can be accompanied by an unmotivated decrease in mood, anxiety, obsessive disorders (when you can’t tear yourself away from meaningless actions), persistent sleep disturbances, and irritability. It can be unpleasant and unusual sensations in the body - not just a headache, but a boring, migrating, shooting. Disorders of the neurotic level are characteristic of every person, but they should alert, because they can lead to a decrease in the quality of life. In addition, these can also be symptoms of a serious mental illness.

There are also symptoms that are obviously the beginning of a more serious mental disorder. For example, auditory deceptions - there is no one around, but you hear some words, sounds. Or derealization - when the environment begins to be perceived differently, it becomes gloomy, extremely unusual, and this accompanies you all the time. This is also the appearance of a feeling of a special attitude towards you from others - from just attention to, perhaps, persecution. These disorders sometimes very quickly acquire such a character that the person does not complain, but relatives begin to notice something unusual. For example, a person becomes withdrawn, although he used to be sociable, begins to behave strangely, unusually: suddenly curtains the windows, often looks out the window, looks around, as if noticing some kind of surveillance, or whispers something and with someone - then it talks.

One of the early manifestations of mental illness is apathy, when a person who has been fond of many things loses interest in them; when he woke up and did not find the strength to get up; when he has not done anything yet, but is already tired; when the circle of his activities begins to shrink and a person spends time unproductively. Very often, with apathy, people stop performing elementary hygienic actions. This may be a symptom of an incipient illness, but others begin to accuse the person of being a lazy person. Parents may not see the disease for a very long time - the child is changing before their eyes, but they do nothing.

Practice shows that even if a person who has schizophrenia (this is what scares everyone, although it can be completely non-malignant), during the first year is in the field of view of a good psychiatrist, then in 80% of cases it is possible to achieve deep and prolonged remission. But, unfortunately, people who have been ill for many years often find themselves at the initial appointment, and next to them are relatives who do not see this. It is strange when people come even from a medical family, who noticed the first changes 7 years ago, but came to their senses only now. Psychiatrists are often the last link when people seek help.

Why is psychiatry so scary? It is customary to be afraid of people with mental disabilities, and besides, to be afraid to go to a psychiatrist. Where does this fear come from?

- Historical roots. If we take, for example, the Middle Ages, then in Europe, in such enlightened countries as Italy, Spain, France, tens of thousands of the mentally ill burned at the stake - they were burned as a repository of evil spirits. And at the same time, in the Middle Ages, it was in Russia that there was a much more humane attitude towards them. Of course, they both wandered and had no shelter, but they were somehow welcomed by monasteries, they were considered holy fools. And not so long ago, during the French Revolution, this is the end of the 18th century, Philippe Pinel, a very enlightened person, began to remove the chains from the mentally ill. At a time when the motto of the revolution was "Liberty, equality, fraternity", such a move was considered abnormally bold. Then, indeed, on chains, as well as on bare floors, in hunger and cold, they kept the sick. And it was with him that the era of non-restraint in psychiatry began. But still, the mentally ill have always been afraid, because this is how a person works - from everything that is incomprehensible and scary to him, he tries to isolate himself. What can I say, the oldest hospital in Moscow named after Gilyarovsky allowed people to come and look at the mentally ill for money. And until recently, there were not so many methods of treatment. I started working in psychiatry in 1959 at the age of 15 as an orderly, then as a nurse, then as a doctor. And then among the students it was believed that it was better to shoot yourself than to be distributed in a psychiatric hospital. There could have been 120 people in a 60-bed ward, many patients were naked, there was a stink of stool. Many years of detention in hospitals was a frequent occurrence, because there were no drugs that could eliminate psychomotor agitation and other acute mental disorders in order to begin the socialization of patients. And despite the fact that psychiatry as a whole has changed a lot thanks to psychopharmacological agents, the appearance of hospitals has changed radically, the need to constantly stay in mental hospitals has disappeared, this centuries-old trail of rejection of psychiatry and fear of it has remained.

The oldest hospital in Moscow named after Gilyarovsky allowed to come and look at the mentally ill for money

- How is the image of a person with mental disabilities presented in the media?

Ten years ago, the Center for Mental Health of the Russian Academy of Sciences conducted a very broad study, which analyzed most of the serious media - television, radio, print. The study statistically calculated how the image of a mentally ill person is presented in the media. It turned out that he is presented as follows: 80% - a rapist (murderer, sexual rapist, someone who can cause physical harm), 60% - a person with unpredictable behavior, 40% - an eccentric (in our films, both psychiatrists and mentally ill people are all what - something wonderful, and the psychiatrist is also necessarily bald and with ridiculous protruding ears), and in 10% of cases the leading media say that all people with mental disabilities should be isolated. Now, I think, the situation has changed somewhat for the better, but not radically. There is an interest in psychiatry in the media, but this topic is not presented rationally, not objectively. The editors are more interested in some rumors, conjectures, sensations that distort the real picture and form a stigmatizing attitude towards psychiatry in people.

- How many really dangerous people with special needs of mental development?

If a person commits a serious offense and the investigator has even the slightest suspicion that he suffers from a mental disorder, the investigator issues a decision on a forensic psychiatric examination. This is a very thorough examination: it is carried out on a commission basis, all documents are collected, all kinds of examinations are made. It turned out that only 15% of all those who committed such offenses were recognized as mentally ill, and the court ruled that they were insane. Please note that 85% are recognized as sane and mentally healthy. Although, as we see, the media believe the opposite. Let's take the other side. Who is the victim of rights violations? They are much more likely to be mentally ill. Moreover, even state organizations can violate rights - all these ZhEKs and DEPs, which you have to contact on a daily basis.

I should note that the vast majority of the mentally ill still work, study at universities, but at the same time they are also observed in neuropsychiatric dispensaries.

- What to do if you see a person in a public place who behaves strangely?

If this is a pronounced mental pathology and he clearly does not need an ambulance, for example, a person with a hallucinatory disorder is waving his arms and talking to himself, I would advise you to call the service that provides such assistance as quickly as possible, and limit yourself to observation and, if possible, prevent adverse development of a situation in which, as a rule, the patient himself suffers. For example, you will see that a person is sitting down and holding his heart - what will you do? Call an ambulance. And it's the same here. It may be that a medical worker will provide assistance on the spot and the person will go home. By the way, often, especially in transport, panic attacks occur when a person is terrified that he may now die. Sometimes he begins to faint, and here you need to try to provide physical support, but it is better to call an ambulance too.

- Is it true that there are seasonal exacerbations?

All functions in the body have a certain cyclicity. Even if you do not take psychiatry, many people feel differently in different seasons. Indeed, in autumn and spring, the body weakens as a whole, some other additional factors (environmental, internal) occur, and the mechanism in the disease is triggered. Each of us has a threshold of a certain height, and every day there are a lot of stimuli that are below this threshold, and we do not react to it. And in moments of general weakening of the body, this threshold can become lower, then the same stimuli become higher than this threshold - and the person begins to feel them. Very often, for example, in women, exacerbations occur during periods of menstruation, menopause, after childbirth. These are also cycles. When we are engaged in psychoprophylaxis, we often draw the attention of women who have suffered traumatic brain injuries or certain diseases to this. It also happens that a person gets sick with the flu, and his mental disorder worsens. Such people should know that during these periods you need to be careful.

- There is a popular opinion that mental illness is not completely cured at all. How true is this?

I believe that in general, no disease is completely cured - not only in psychiatry, but also in other areas of medicine. For example, pneumonia is not treated, because some kind of scar still remains. But is diabetes or myocardial infarction finally cured, if we mean complications from it? That mental illness can not be cured completely. Another thing is that you need to save a person from those mental disorders that interfere with him.

The task is different - how to achieve that a person can fully live, love, give birth to children, become a brilliant writer or artist. By the way, wherever you move your hand in creativity, there are mentally ill people everywhere, to whom I treat without looking at their mental illness, appreciating their creativity. Although, as a professional, of course, I understand the mental disorders of Pushkin, Dostoevsky, Tolstoy, Vrubel, and Scriabin. But, despite their talents, they experienced a very difficult life associated with a mental disorder, just like the mentally ill who did not achieve such greatness. Nevertheless, we admire the products of their creativity. Therefore, any task of a psychiatrist, cardiologist, endocrinologist, dermatologist is to achieve the optimal result. And this is the most active and comfortable life of a person with mental disorders.

- How do you feel about the fashion for psychotherapy?

I don’t understand why you are talking about fashion, because psychotherapy has been known for a long time - this is the same church. But as to who should conduct it, there is a lot of controversy. My personal opinion is that psychotherapy is a technique that can only be used by certified professionals. A psychotherapist is the second education of a psychiatrist who, having passed the appropriate training, receives a diploma and can master a number of techniques that will be based on understanding the essence of the disease. And then, besides, he has the right to prescribe drug therapy.

Psychotherapists are the profession that psychologists aspire to, who are also divided into several groups. Some psychologists get a record in their diploma that they are medical or clinical psychologists who can be admitted to the patient and carry out a lot of different methods of psychological correction. But in order to understand what this disorder is and whether it exists at all, one must be a doctor. A psychologist without a medical education can cause irreparable harm to a patient.

Entire psychological societies do not agree with this - they believe that they can engage in psychotherapy. In principle, experienced medical psychologists know some techniques and can effectively help a person with borderline disorders. But I believe that the best option is when the psychiatrist and psychologist are co-therapists, working together with the patient.

Many universities have psychological faculties, where they write in the diploma: "Practical psychologist, teacher of psychology." He has no right, from my point of view, to carry out psychological work with patients. But if a person simply has problems with her husband, mother, children, then a non-medical psychologist can work with him, provided that seeking help does not contain a clinical component leading to these problems.