Personal experience: how to choose a psychiatrist, what types of psychotropics are available, is schizophrenia treatable and is it possible to cope with mental illness on your own?

Short description

Clinical psychology methods are used in classical medical practice. This area began to actively develop at the end of the 19th century and is closely related to psychiatry. There are several sections of clinical psychology: psychotherapy, neuropsychology, psychosomatics and others. Clinical psychologists have in-depth knowledge of anatomy and medicine. The direction is wide-ranging, because specialists are responsible for the harmonious development of the psyche, adaptation, psychological support and rehabilitation of patients.

Problems that a clinical psychologist helps solve

After the main course of treatment, every person who comes to the attention of a psychiatrist or psychiatrist-narcologist is usually prescribed a course of post-treatment rehabilitation, which implies a mandatory visit to a psychotherapist. A course of psychotherapy is usually designed for a certain period, but is always built individually, based on the person’s illness and medical indications.

The main goal of psychotherapy is to resocialize the patient, return to normal life, return to work or study. That is, assistance in restoring relationships with society damaged by the disease. Often, people who are in trouble, who have experienced psychosis, or who have gone through a period of addiction, face difficulties in returning to the life that is familiar to an ordinary person.

In addition to social problems, such as employment or study, illness causes conflicts in the family, misunderstanding of loved ones, or categorical rejection of one’s illness. These and many other problems are helped to be solved by a clinical psychologist, who is well aware of the nature of both mental disorders and the stages of addiction formation.

Features of the profession

Clinical psychologists most often interact with people who experience difficulties in issues related to adaptation, self-realization, and personality development. These processes depend on the social, spiritual and physical state of the patient. Clinical psychologists use the following methods:

• conversations, observation;
• psychophysical, anamnestic, biographical, experimental and psychological methods;
• studying the products of activity and creativity.

A clinical psychologist at a university studies a whole range of natural science disciplines, as well as the anatomy of the central nervous system, neuropsychology and neurophysiology, psychodiagnostics, etc. Certified specialists perform the following types of work:

• collecting anamnesis, performing psychodiagnostics;
• development of measures aimed at correcting the patient’s psycho-emotional state;
• providing assistance in self-identification, social adaptation, and establishing family relationships;
• preparing a drug treatment regimen if necessary;
• conducting a psychological examination;
• social activities within the framework of assistance to vulnerable segments of the population: children, disabled people, etc.;
• drawing up conclusions based on the results of the work performed.

They work with different groups of people. They provide assistance to patients who have suffered psychological trauma, suffer from acquired or congenital diseases, and feel the need for social adaptation, for example, after serving a sentence in prison. Please note that clinical psychologists do not work with severe mental conditions: schizophrenia, bipolar affective disorder and others.

Application of clinical psychology in the practical work of psychologists

The range of applications of clinical psychology is huge - any serious illness is associated with stressful situations and emotional overload. Such conditions can easily provoke somatic disorders, cause neuroses, or give rise to persistent mental disorders.

The basis of the practical work of psychologists is the prompt provision of consulting and psychological assistance to everyone who needs it. Employees of this category are in demand in medical and educational institutions, enterprises and firms, and various organizations. The benefits of skillful application of clinical psychology in modern life cannot be underestimated. A practicing psychologist is in demand for solving intra-family conflicts and personal problems, difficulties of social adaptation, and other areas of human life.

The practical work of psychologists occurs in two main areas:

• Working with a person who has independently asked for help. The psychologist diagnoses the problem, and if it lies in the area of ​​its implementation (does not require drug treatment), selects methods of influence and implements them to the required extent.
• Determining the need and application of clinical psychology in the workplace. A psychologist working in any team actively monitors community members, the nature of relationships between employees, and their behavioral habits. If any deviations, difficulties in communication, conflicts and other signs of emotional overload are identified, psychological assistance is provided. In the long term, the practical work of psychologists is justified by its positive impact on the successful conduct of any activity.

The practical application of clinical psychology requires a specialist to have serious training and mastery of a large arsenal of psychotherapeutic techniques. They are necessary to correct behavior in the following situations:

• anxiety, stress;
• psychological problems of intrafamily relationships;
• increased emotional sensitivity;
• low self-esteem, complexes;
• age crisis and others.

To carry out practical work and correct the client’s emotional state, a psychologist can use:

• method of systematic desensitization;
• biographical method;
• relaxation;
• teach the client ways of psychological self-regulation.

Do not underestimate the use in clinical psychology of such a method of therapeutic influence as a frank conversation - a heart-to-heart conversation. Understanding and participation on the part of the psychologist can restore the client’s emotional balance, self-confidence and positive attitude. A psychologist’s extensive experience in practical work will allow, during a conversation, to direct a person’s thoughts in the right direction, find the optimal solution to the problem and abandon destructive behavior.

Pros and cons of the profession

pros

1. Clinical psychology is a popular field; patients of any age are interested in the services of these specialists.
2. A huge selection of forms of professional activity: private practice, corporate or scientific work, webinars, etc.
3. High level of income, which directly depends on the activity and professionalism of the clinical psychologist.
4. The profession is suitable for people with disabilities (impaired function of the upper and lower extremities), because services can be provided in the format of Skype conferences.

Job responsibilities of a specialist

The job responsibilities of these professionals are to study and eliminate social and behavioral problems that cause people suffering in their lives. More specifically, these problems cover a wide range of issues, from emotional problems such as depression , to behavioral disorders such as ADHD or autism, to serious mental health problems such as schizophrenia or dissociative identity disorder.

Some clinical psychologists work in laboratory settings conducting research on the aforementioned mental health issues. In this capacity, the focus is on developing a better understanding of human behavior through research aimed at improving the diagnosis and treatment of these disorders. In a laboratory setting, a clinical psychologist will be responsible for a variety of responsibilities, from designing experiments and recruiting participants to collecting and analyzing data.

Training to become a clinical psychologist

The profession cannot be mastered in courses or in college, so the path of an applicant who decides to study this branch of psychology lies in a university. It is worth making a choice in favor of the specialty “Clinical Psychology” (code: 05.37.01). To enter, you must pass the Unified State Exam in the following subjects:

• biology – specialized exam;
• Russian language – compulsory exam;
• social studies, mathematics, foreign language - at the choice of the university.

The area of ​​training has many profiles: “Pathopsychological diagnosis and psychotherapy”, “Clinical and social rehabilitation and penitentiary psychology” and others. The duration of training is 5 years; the profession does not require further residency training. Documents can be submitted to medical or multidisciplinary universities that offer the program in question.

Universities

Moscow State University named after M.V. Lomonosov

Clinical psychology (Faculty of Psychology, M.V. Lomonosov Moscow State University)

Ural Federal University named after the first President of Russia B.N. Yeltsin

Clinical psychology (Ural Humanitarian Institute, UrFU)

Chelyabinsk State University

Clinical psychology (Faculty of Psychology and Pedagogy)

Russian State Humanitarian University

Clinical psychology (Institute of Psychology named after L.S. Vygotsky Russian State University for the Humanities)

First Moscow State Medical University named after. I.M.Sechenova

Clinical psychology (I.M. Sechenov First Moscow State Medical University)

Psychiatrists in Moscow

Who is a psychiatrist?

A psychiatrist is a doctor who has undergone special training in the diagnosis, treatment, prevention, and examination of mental illness. Specialists in this field know the specifics of all somatic and neurological manifestations in a wide variety of mental pathologies. They master modern methods of psychotherapy and are constantly mastering new, more advanced and modern ones.

What do psychiatrists do?

Psychiatrists identify and treat a wide variety of mental disorders. The current specialist knows not only the clinical manifestations of pathologies in his field.

Psychiatrists are erudite specialists also in the areas of:

• psychology;
• philosophy;
• theology.

In addition, they have high moral qualities and spiritual values. Before making a diagnosis, a psychiatrist needs to conduct many types of tests, such as:

• neurophysiological;
• biochemical;
• hormonal study.

Such patients in Moscow are also prescribed examinations of the cardiovascular, digestive, respiratory and other vital systems of the body.

As a result of examinations, psychiatrists make the following diagnoses:

• any types of depressive disorders, including postpartum depression;
• alternation of mania and depression;
• fears, obsessions, phobias;
• anxiety states;
• behavioral disorders, severe character, psychopathy, etc.;
• various kinds of sexual disorders;
• reactive states;
• consequences of traumatic brain injuries;
• consequences of cerebrovascular accidents;
• epilepsy of various etymologies;
• all types of schizophrenia;
• age-related sleep disorders, senile depression;
• cerebral atherosclerosis
• Alzheimer's disease, etc.

Psychiatrists in Moscow also deal with solving family and interpersonal conflicts.

What symptoms are referred to psychiatrists?

They are referred to a psychiatrist if:

• depressive states;
• emotional disorders - despair, melancholy, oppression, suffering, depressed mood;
• constant feelings of anxiety, internal tension, anticipation of trouble;
• unreasonable irritability;
• persistent feelings of guilt, frequent self-accusations;
• constant dissatisfaction with oneself, lack of self-confidence, low self-esteem;
• loss of interest in the world around you;
• lack of ability to experience any feelings and so on.

Physiological manifestations may include insomnia or drowsiness, changes in appetite, constipation, decreased or absent sexual desires, weakness, increased fatigue, etc. Patients who need to see a psychiatrist in Moscow experience changes in behavior, which manifests itself in passivity, cessation of communication, refusal entertainment. There are situations when contacting a specialist is extremely necessary because there is a threat of suicide.

Which universities in Moscow train psychiatrists?

Specialists who are able to understand mental disorders of people of different ages and social categories are trained in many universities in Moscow. Departments of Psychiatry operate in:

• RMAPO;
• MONIKI;
• Federal State Institution UMTS UD of the President of the Russian Federation;
• GBOU VPO RNIMU im. N.I. Pirogov;
• MMA im. THEM. Sechenov;
• Institute for Advanced Training of Physicians NMHC named after. N.I. Pirogov and many other universities.

Each department has its own specialization. This could be personality-oriented, ethnic, social psychiatry, and so on.

Famous Moscow specialists

Human mental illnesses have been studied since ancient times. Egyptian papyri, the Hindu book “Vedas” of the 15th–16th centuries BC tell about the conduct of such research. e. Hippocrates became the founder of modern psychiatry. The flowering of science began with him.

In 1880, the Department of Nervous and Mental Diseases was founded at Moscow University. Such prominent scientists as Pavlov, Sechenov, Illinsky, Kashchenko, Litvinov and many others conducted research in the capital.

Place of work

Clinical psychologists will be able to find work in clinics, rehabilitation or specialized centers, and trust services. Hospices, orphanages, as well as correctional colonies, crisis centers, government agencies, etc. are interested in them. Often specialists are engaged in private practice, in which case they can serve as corporate or family psychologists, conduct webinars, Skype conferences, group trainings.

Free preliminary consultation with a psychiatrist

A free preliminary consultation in psychiatry can have a significant positive effect if the doctor knows how to listen and hear the patient. Our clinic employs specialists of the highest qualification category, doctors and candidates of medical sciences, professors. They all provide consultative treatment. It is convenient to contact a psychiatrist online for consultation if the patient does not know which doctor he needs to see: a psychiatrist, psychotherapist, sexologist or narcologist. Communicating remotely, it is impossible to diagnose and prescribe medications. But at a free preliminary consultation, you can give the patient important advice and recommend a specialist.

An online consultation with a psychiatrist is appropriate if the patient and the doctor have already met in person several times before communicating via Skype or chat. The specialist visited the patient at home, or he underwent inpatient treatment. The doctor is well aware of both his diagnosis and symptoms. If the patient’s condition is stable and requires only observation, then there is no need to waste time traveling to the clinic. An online consultation with a psychiatrist will help. It is not customary to advertise requests for psychiatric help in our country. A diagnosis made by a doctor of this profile can be the end of a career for someone or the reason for dismissal from work. Psychiatric registration entails certain restrictions and may cause negative reactions from others. A free preliminary consultation in such a situation is very convenient and useful: it is carried out remotely and the doctor has the opportunity to explain to the patient that there is no psychiatric registration in paid medicine.

An online consultation with a psychiatrist can be prescribed as part of psychotherapeutic techniques, provided that the doctor has the appropriate additional specialization. With such interaction between the psychiatrist and the patient, there is not always a need for personal contact. Auto-training, individual consultations, practical advice on how to improve communication with people, how to control emotions, how to overcome fears can be obtained via Skype or phone. This will not make them lose their value and significance. An online consultation with a psychiatrist will help you deal with hidden conflicts in work relationships, understand the difference between loneliness and solitude, true and false values, find your calling, and find a place in life. In real time, you can tell the doctor about the problems that bother you: instability of mood, causeless worries, depressing state of mind. If you need a free preliminary consultation with a psychiatrist, call our contact phone number.

How to choose the right psychiatrist and psychiatric hospital?

Today, a patient with a mental disorder and his relatives have a wide range of choices where to receive treatment - from public hospitals and private clinics, even to foreign clinics. The choice is influenced by a lot of factors - advice from friends, advertising, financial resources, trust or distrust in certain organizations, the desire for anonymity of treatment. Unfortunately, the main thing - professionalism - usually remains behind the scenes. Why is that? There are a number of misconceptions about the work of a psychiatrist that I would like to dispel. “All doctors are approximately the same in qualifications” No. Today, medicine is a rapidly developing field of knowledge, the amount of information in which actually doubles every 5 years. To be a good specialist, a doctor must not only receive a good basic education (which, alas, is rare in itself), but also constantly engage in self-education and improve his skills. In fact, few people do this, so doctors can differ greatly from each other in terms of the amount of knowledge and, accordingly, in the quality of treatment. That is why looking for a clinic “around the corner”, without paying attention to the doctor’s qualifications, is a pointless exercise. As a result of saving time, you can get an incorrect diagnosis, incorrect treatment and only make the situation worse. Diagnostics is not needed, look at me, talk and prescribe a drug based on your experience.” The other extreme is to overestimate the doctor’s qualifications and begin to consider him a psychic who can make a diagnosis based on a conversation. This opinion is partly to blame for the classification of diseases that include purely external symptoms, without taking into account disturbances in the structure and functioning of the brain, and the causes of disruption of its functioning. It is worth understanding that even the best psychiatrist cannot detect a cyst in the head or epi-activity on an electroencephalogram. “I cannot evaluate the doctor’s qualifications” This is partly true. Even professionals often find it difficult to assess a colleague’s qualifications. However, I regularly meet relatives of patients and patients themselves who understand their problem better than the average doctor. If you read about various methods of diagnosing and treating the disease on trustworthy sites (Wikipedia, database of PubMed articles, etc.), you can make a list of questions for the doctor and evaluate how completely and correctly he answers. It is also worth observing whether the doctor asks for research results, looks at EEG curves, or simply reads the description, or can show brain structures on an MRI. A competent doctor understands both brain anatomy and neurophysiology. The completeness of collecting information about heredity and past somatic diseases also indicates the qualifications of the doctor, because many mental disorders develop due to diseases of other organs. Choosing a clinic is in many ways similar to choosing a psychiatrist. Very often, the choice is made based on the advice of those relatives or friends who have already encountered the problem of hospitalization in a psychiatric hospital. A psychiatrist you know may also recommend going to a particular psychiatric hospital. Advice can also be given by the doctor (psychotherapist, psychiatrist, neurologist, psychologist, etc.) to whom the family relatives have already come for consultation.

In some cases, relatives of a mentally ill person are faced with the need for urgent hospitalization in a psychiatric hospital, often even involuntary, that is, without the consent of the patient. If the patient has already been to a psychiatric hospital several times, then most likely he will end up there, especially if the attending physician made a good impression. However, let's try to answer the question posed above about hospitalization in a psychiatric hospital. Let's start with the fact that there are public and private psychiatric hospitals or clinics (the latter term is more often used in relation to private psychiatry). Both cases have their pros and cons. State psychiatric hospital In a state psychiatric hospital, of course, treatment cannot be anonymous , but it costs less. It cannot be called completely free, since usually relatives give gifts to the attending physicians or purchase expensive medicines. In addition, today most state psychiatric hospitals have paid departments with “superior” rooms, but with the same treatment methods as in free departments. Unfortunately, in a state psychiatric hospital, diagnosis and treatment are carried out under the banner of “protocols” and “standards”. A public hospital doctor is bound by standards, regulations, and the hospital's procurement of certain drugs. He does not have the right to use modern methods of diagnosing and treating mental disorders, for example, taking high-resolution MRI images of patients (3 Tesla), or studying connections between brain structures using diffusion tensor imaging. Most likely, in a state psychiatric hospital the patient will not be able to undergo a full instrumental examination. At best, he will have a regular electroencephalogram, but not 24-hour EEG monitoring, evoked potentials, or nocturnal sleep patterns. Laboratory testing is limited to a general blood test, an abbreviated biochemical analysis, and the exclusion of several dangerous infections. The work of a psychologist is also limited; preference is given to group methods of work and a short pathopsychological study. That is, diagnosis and treatment are limited to the most necessary and may be clearly incomplete. In a state psychiatric hospital, relatives will not be able to control the treatment process, much less be with the patient. Sometimes there is a shortage of drugs needed for treatment in state psychiatric hospitals. The situation is highly dependent on the purchasing service, but doctors will most likely deny this fact. Patients are usually in 4-6-bed wards and have little opportunity for quality leisure time. Pastime is most often limited to smoking and “learning” from other patients how to properly hide medications so as not to take them. If the patient is too bothersome or restless, the staff on duty may use tranquilizers or strong antipsychotics. Private psychiatric clinic Let the reader not think that everything is perfect in private psychiatric clinics, and do not rush to hospitalize his relative in a private psychiatric clinic. This has its drawbacks. There are quite a lot of private psychiatric clinics in big cities and they are usually connected in one way or another with the chief doctors of psychiatric hospitals or with the heads of departments of psychiatry. Private psychiatric or drug treatment clinic? Most private psychiatric clinics began with the treatment of drug addicts and “digging at home.” With the advent of the crisis, many added an additional profile of mental health services. Naturally, such clinics will be inferior in quality of work to purely psychiatric clinics, whose staff have experience working specifically with psychiatrist patients. In addition, in such clinics there are many patients with addictions, which can have a negative impact on the patient, especially a young one or one susceptible to the opinions of others. Commercial interests In most private psychiatric clinics, management tries to save on treatment, especially if the patient is treated on a per-day basis, without additional services. On the other hand, the patient's relatives will be offered the necessary diagnostic and treatment procedures for a separate payment. For example, in one clinic expensive TMS or neurobiomodulation may be included in the payment, in another they will be asked to pay for them separately. It is worth finding out in advance the scope of services included in the price of a hospital stay. It is also important to find out how many seats there will be in the ward. In wards for 4-6 people, exchanges of experience are often undesirable, for example, in particular, how to avoid taking medications. In some private (mixed) clinics, sexual contacts between patients even occur, especially in bipolar disorder. Quality of work The quality of treatment depends on the professionalism of the staff and treatment methods. It is worth finding out who your attending physician will be, the quality of treatment will depend on this. There is an opinion that in private clinics they “cheat people for examinations.” I believe this is not the case; on the contrary, in most cases the necessary examinations are not prescribed. I rarely see modern methods of diagnosis and treatment in private psychiatric clinics: pharmacological genetic research or whole genome research, studies of the white matter of the brain, monitoring of drug concentrations in the blood, nasal electrophoresis of psychotropic or other drugs, stimulation of certain brain structures using a magnetic field (TMS) ), weak direct or alternating current, with preliminary navigation of the target of such influence. Usually a psychologist conducts a pathopsychological examination, but will not do a neuropsychological one. Individual psychotherapy is most often selective for individual patients, group therapy dominates, and the recruitment of such a group is random. Family psychotherapy, meta-cognitive and cognitive training are also rare. In the clinic, you will probably hear about declarations of the “team method of work” (psychiatrist, clinical and social psychologist), but it is extremely rare that you will see it implemented in reality. “Foreign people will help us” Some relatives of patients collect money for treatment in Israel, Germany, the USA and other countries, believing that foreign specialists are definitely better than Russian ones and they will be the ones who can help. If you go to the best clinics in the world, such as Mayo USA), this opinion is fair. However, there are a lot of clinics abroad that attract patients solely because of their location (brand). Often they are founded by immigrants from Russia, and the staff there is also Russian. What is the point of going to a Russian clinic abroad and overpaying? In European countries the situation is different. I visited several clinics in the UK, Switzerland, Denmark and Germany. One day of stay in a good private clinic in Europe costs about 1000 euros. Patients often end up there due to calls from marketers, recommendations from officials or doctors who simultaneously work in both a public clinic and a private one. You may be surprised, but abroad you will again not find a full examination of a patient with a mental disorder. No one is going to give you a high-resolution MRI, tractography, 24-hour EEG monitoring, determine the concentration of a psychotropic drug in the blood, or do a genetic study. Forget about being close to the patient and monitoring the treatment process (“thank you for being treated for your money”). I note that most private psychiatric clinics abroad are psychotherapeutic and are not associated with the treatment of acute conditions. Unfortunately, even high-quality psychotherapy in a foreign language or through an interpreter is ineffective. Research centers Research institutes are traditionally considered a place where the best specialists in their field gather. However, today the majority of institute employees are primarily engaged in writing scientific articles (the more they write, the more they get paid). Each employee must write a certain number of articles per year. In addition, employees participate in a host of conferences and mandatory events that take place almost every week in large cities. As you can see, there is little time left for patients. Separately, it is worth mentioning the connection with pharmaceutical companies, which often cooperate too closely with research institutes. In addition, not all commercially available diagnostic methods are used in institutions. It is unlikely that you will find monitoring of drug concentrations in the blood, pharmacogenetic testing or tractography.