[Psychotropic drugs used in a psychiatric hospital (pharmaco-epidemiologic aspects)]. / Psikhotrropnye sredstva, primeniaemye v psikhiatricheskom statsionare (farmakoépidemiologicheskie aspekty).

The aim of the study was to optimize psychopharmacotherapy in a big psychiatric hospital. It was conducted in Moscow Alekseev psychiatric hospital No 1, using a method of comparison of standard psychotropic treatment and medication strategy suggested by the expert group. An analysis of the treatment of 966 patients with different mental disorders revealed that 78.3% were in need of neuroleptic assignment that was in line with routine practice. The expert's conclusions were postulated as follows: a need in phenothyazines is significantly lower than that observed in practice. Xantens and tyoxantens (chlorprothixene, flupentixol, zuclopenthixol, zuclopenthixol decanoate, zuclopenthixol acetate), benzamides (sulpiride) and such atypical antipsychotics as risperidone, olanzapine and quentiapine are underused in the treatment. Comparing to usual practice, more patients (35.8%) need antidepressants treatment. Thymoleptics should be assigned in greater daily doses. Selective inhibitors of serotonin reuptake (paroxetine, fluoxetine, citalopram, sertraline), reversible MAO A inhibitors (pyrazidolum), "double-action" drugs (mirtazapine, milnacipran) are recommended for wider usage. Less patients (33.4%) are in need of tranquilizers, though a number of medications used is consistent with a recommended one. Normothymics may be assigned to essentially less part of the patients and 18% of them need nootropics that is consistent with routine practice.

[Psychosomatic disorders (clinical picture, epidemiology, therapy and models of health services]. / Psikhosomaticheskie rasstroistva (klinika, épidemiologiia, terapiia, modeli meditsinskoi pomoshchi.

53.6% of the patients of general hospital suffer from psychosomatic disorders (PSD). Two-dimensional (psychologic/ clinical) model of psychosomatic interrelations is presented which proposes the estimation of the influence of both somatic and psychological factors within PSD pathogenesis. The clinical classification of PSD includes 4 types: somatization (somatoform disorders)--organ neuroses--27%; psychogenic (nosogenic) reactions--57%; stress-related exacerbation of the medical illness (symptomatic lability)--14%; exogenous (somatogenic) reactions--1%. Except psychotherapy, PSD treatment demands pharmacological intervention (including tranquilizers, antidepressants, cerebroprotectors and neuroleptics). Pharmacotherapy should be proceeded with the account of both its possible somatic effects and its interaction with conventional medical agents. The results of the follow-up study prove superiority of psychopharmacotherapy over psychotherapy in terms of long-term efficacy. The most effective model of the organization of psychiatric care in PSD clinic is liasion psychiatry (psychiatrist consults and general practitioner treats). Inpatient treatment of non-psychotic PSD patients requires an organization of specialized units within a general hospital.