The use of methods of psychiatric education in the prevention of mental pathology by a psychiatrist outpatient consultation

Introduction

Hygienic education and upbringing of the population in order to involve them in active participation in the protection of personal and public health is an important section of the preventive activities of health authorities and institutions, the tasks and content of health education. In the work of a psychiatrist, psychoeducation, psychiatric education of patients and psychoprophylaxis include a set of educational, agitation and propaganda activities aimed at promoting a healthy lifestyle, preventing diseases, maintaining and strengthening health, increasing the working capacity of people, and prolonging their active life [1-3]. Requirements for the preparation of a report for specialists with higher medical and pharmaceutical education formulate the provision on the sanitary and educational work of a doctor as follows: Section 8. [4]. Sanitary and educational work (reflects the work done during the reporting period, indicating the topics of lectures, publications in the press, radio and television appearances). It follows from this document that a specialist who draws up documents for a qualification category must be engaged in sanitary and educational work, have publications in print and speak on radio and television.

Aim

Determine the role and place of psychoprophylaxis of psychiatric education and in the structure of the work of a psychiatrist of an outpatient consultation appointment.

Material and Methods

The analysis of 5 qualification works of a psychiatrist (1997, 2002, 2008, 2013 and 2018) was carried out for sanitary and educational work as a part of the mandatory requirements for paperwork when they are submitted to the Attestation Commission on the assignment of qualifying medical categories in psychiatry. The depth of the study was 24 years [5-9].

The attestation commission under the Ministry of Labor and Social Development of the Russian Federation (Moscow) awarded the applicant with the highest qualification category in the specialty “Psychiatry” on 04.07.1997, which was confirmed in December 2002 by the attestation commission of the St. Petersburg Institute of Advanced Medical Expertise, and 18.04.2008, 28.03.2013 and 20.02.2018 - by the Republican Attestation Commission of the Ministry of Health of the Komi Republic (RK).

When working on the material, the following methodological approaches were used: systemic, complex, dynamic, normative, quantitative and situational. Analysis methods included: historical, analytical and comparison. For the analysis, the following techniques were used: grouping, continuous and selective observations.

The study was conducted on the basis of the State Autonomous Healthcare Institution of the Komi Republic “Consultative and Diagnostic Center of the Komi Republic” (GAUZ RK “CDC RK”), which provides highly qualified consultative and diagnostic, specialized medical care to the population of the Republic of Kazakhstan and organizational and methodological management of diagnostic services of health care institutions within regional administrative entities. RK is located in the Far North-East of the European part of the Russian Federation (RF) and belongs to the subarctic territories. The main task of GAUZ RK “CDC RK” is to carry out high-quality comprehensive diagnostics of diseases available to the general population and provide highly qualified consultative care using highly effective medical technologies on an outpatient basis. It serves patients in 20 administrative territories of the Republic of Kazakhstan and part of the Arkhangelsk region. For this, the institution has concentrated modern diagnostic and technical equipment, and a team of qualified specialists has been formed.

Results

Psychiatric reception in the advisory department of GAUZ RK “CDC” is carried out by one specialist. Psychiatrist’s consultations not only complement but also reveal to the internists the peculiarities of somatic pathology with signs of changes in the mental sphere [10,11].

Measures to protect and promote the health of patients with mental illness are an important part of the work of a psychiatrist. Sanitary educational work in psychiatry is aimed at increasing the level of knowledge of the population about mental disorders, mastering methods of protection from stress, the harmful effects of bad habits. Individual psychiatric education and training accompanies the entire treatment process.

Psychoeducation of patients with mental disorders

A psychiatrist works with patients individually with signs of mental pathology and through the dissemination of medical and hygienic knowledge, education of sanitary and hygienic skills in order to preserve and strengthen health, improve sanitary and hygienic culture, taking into account gender, age, climatic and geographical features, national customs, traditions and other factors can affect the individual health. Therefore, during the consultative outpatient appointment, which takes 30 minutes, the forms of individual psychological education and psychiatric education of the patient, and, if possible, his relatives and (or) family members are used as much as possible Table 1.

With all 6255 patients without exception, who consulted the psychiatrist of the consultative department of GAUZ RK “CDC” in 2015-2017, 6255 individual conversations were held on the prevention of mental illness. They are a very important tool for influencing the psychological capabilities of the human body to change the health balance in a positive direction. Increasing health resources should be provided by a psychiatrist with all available measures of a healthy lifestyle (nutrition, physical activity, a positive psycho-emotional climate in the family, a developing hobby, etc.). During the reception, the psychiatrist constantly explains to the patients what pathology the patient has, what kind of treatment is required and what preventive measures for mental disorders exist (psychoprophylaxis, psychohygiene). Psychiatric education involves engaging the patient in individual prevention and participation in the treatment of an already developed pathology [12-14].

Psychiatric education

How to prevent mental illness? Mental health, like physical health, is the main component of a person’s overall well-being, therefore it is important to maintain its stability. The degree of social realization of an individual directly determines the state of the human psyche (life priorities, career, public recognition). The ability to adapt to difficult conditions and adequately respond to stressful situations indicates a person’s good mental health. It is important for the psychiatrist to assess the adequacy of the patient’s reactions, since they determine the state of the compensatory-adaptive systems (nervous, endocrine, etc.) and the possibilities of the mechanisms of mental self-regulation (psychological defense, etc.), thus characterizing the health potential. The doctor must do all this during a consultative outpatient appointment to find out the relationship between the health potential and the factors acting on it, that is, to determine the health balance. To choose the right treatment tactics, a psychiatrist needs indicators that objectively reflect the quantity, quality and composition of the patient’s mental health. Often, the time spent on such an admission significantly exceeds the released limits [15,16].

Primary mental health prevention measures include patient actions that are available to everyone. These include:

1) Adequate rest and healthy sleep for at least 8 hours a day. Deep sleep helps to restore the nervous system and is an excellent preventive measure against the development of mental illness.

2) Moderate daily physical activity. The need for regular exercise or other work related to movement for the patient after consultation with psychiatrists should become apparent. Excess adrenaline builds up in the body and can contribute to the development of mental disorders. Exercise burns out excess adrenaline and thus has a fairly strong prophylactic effect.

3) Do what you love. If a person’s main activity is not related to what they love, it is important to devote enough time to individual hobbies (favorite activities, hobbies). It has been proven that it relieves the accumulated psychoemotional stress.

4) Family relationships are critical to good mental health. They should be taken as seriously as possible since regular quarrels and scandals with loved ones are often the cause of mental disorders.

5) The intimate side of life. Prolonged sexual abstinence and / or failure in sexual life often lead to various mental disorders, such as depression. This is an important, very delicate and often discussed in the media issue in the life of a modern person. But the mass media are too diligent and aggressive in shaping a successful life as a consequence of the hypersexuality of the individual. There is a danger here, as excessive sexual activity leads to emotional exhaustion. Mental hygiene and the prevention of neuroses are among the most important topics of health education conducted by a psychiatrist.

In addition to these methods, patients are encouraged to attend various psychological trainings. In the absence of such an opportunity, trainings can be conducted independently. Each person can organize a nervous-emotional discharge for himself using inexpensive available methods: a walk in the fresh air; active rest with physical activity (work at the summer cottage), meeting with friends.

Secondary measures for the prevention of mental pathology include preventing the recurrence of pre-existing diseases. The psychiatrist prescribes them individually, after the patient has undergone a course of treatment.

Working with medical staff

From collective forms of psychiatric education, the psychiatrist widely uses the corporate version, since he works in a medical team, to which patients mainly consult with somatic pathology. For doctors and nurses of GAUZ RK “CDC” lectures were given on the following topics: 1) What you need to know about depression. Depression and somatic diseases; 2) Anxiety in general somatic practice; 3) Mental disorders in traumatic brain injury; 4) Cognitive impairment in old age; 5) Gerontology. Accelerated aging of the population. The main factors of mortality and morbidity in Russia; 6) Somatoform disorders, psychosomatic diseases, somatopsychic disorders; 7) Features of the psyche of an elderly person; 8) Ethics of relationships in the medical team; 9) The killer named Stress; 10) What is oncopsychology? Cancer is a disease of sadness.

The psychiatrist also uses the printed word in specialized psychiatric educational work. They prepared reminders for the doctors of GAUZ RK “CDC”: 1) Alarm. Physical symptoms. Emotional symptoms; 2) Depression. Clinical signs; 3) Ten methods for reducing anxiety.

In connection with the need to correctly refer patients to a psychiatrist for doctors, GAUZ RK “CDC”, city polyclinics and Central regional hospitals, the following methodological letters have been developed: 1) Indications for consultation with a psychiatrist (according to ICD-10); 2) Differential diagnostic criteria for neuralgia and panalgic syndrome of latent depression; 3) Differential diagnostic criteria for the cephalgic syndrome of latent depression and migraine; 4) Differential diagnostic criteria for cardialgic syndrome of latent depression and cardialgia in ischemic heart disease; 5) Differential diagnostic criteria for gastric ulcer, duodenal ulcer and abdominal latent depression syndrome [17].

Methodological and educational work For many years, the psychiatrist has worked in a stable scientific group that promotes healthy lifestyles and life safety. In the sphere of interests of a practitioner: Psychiatry. Mental health and morbidity of the population. Public health and health care of the subarctic region. Social medicine. Implementation of ITU recommendations for the rehabilitation of patients in various professional and age groups. Preventive medicine. Methods for teaching the basics of life safety, emergency medical care in case of injuries and accidents, healthy lifestyle and health-preserving technologies, social and hygienic consequences of HIV infection (AIDS), sexually transmitted diseases and bad habits (tobacco, alcohol, toxic and narcotic substances) in higher and secondary vocational educational institutions. Didactics of subjects “Safety of life” and “Fundamentals of a healthy lifestyle” for non-medical faculties of humanitarian and technical universities. Distance and additional education, active forms of education [18,19].

The psychiatrist (in co-authorship) has prepared the textbook “Fundamentals of Life Safety: Hygiene and Health. Disease Prevention”, intended for students of humanitarian, technical and pedagogical universities studying courses: “Fundamentals of Medical and Hygienic Knowledge”, “Fundamentals of Medical Knowledge and Child Health Protection”,”Fundamentals of Pediatrics”, teachers of the course “Fundamentals of Life Safety” of secondary schools and colleges; and those interested in healthy lifestyles. It examines the issues of hygiene and health of the population on the following topics: Medical valeology, as an academic subject; Major health factors; Ontogenesis as a human life cycle; Hygiene as an educational and scientific discipline; Medical and statistical characteristics of the health of the population; Hygienic characteristics of professional activity; Regularities of the growth and development of the child’s body; Characteristics of indicators and constants of the development of the functional systems of the child; General characteristics of the anatomical and physiological characteristics of young children; Physical and neuropsychic development of the child. Hygiene of pregnancy. Childbirth; Breastfeeding and organization of feeding a child under one year of age; Allergic conditions in children; Rickets; Violation of the musculoskeletal system in children and adolescents; Congenital and hereditary diseases; Family planning; Smoking; Alcoholism; Substance abuse; Addiction; Infectious diseases. Infectious and epidemic processes; Immunity: Disinfection, disinsection and vermin control in the fight against infectious diseases; Respiratory viral infections; Venereal diseases; HIV infection and AIDS (acquired immunodeficiency syndrome) [20].

A psychiatrist (in co-authorship) has prepared a textbook “Fundamentals of Life Safety: Safety and Protection of the Population in Emergency Situations; Self-, mutual and first aid in case of injuries and accidents”. The authors see a medical problem in the fact that more than 25.0% of victims of accidents could have been saved with the correct provision of first aid at the scene (every fourth of the victims). In light of the humanization of the educational process and the preparation of the population of the Russian Federation for adequate (competent) behavior in emergency situations, the main goal of developmental training is to prepare cadets for an independent search for truth, for independence in everyday life, the formation of motives, the assimilation of new ways of activity, the development of readiness to self-control.

A textbook on the organization of safety and protection of the population in emergency situations, the provision of emergency self-, mutual and first pre-medical emergency care in case of injuries, accidents, accidents, disasters and natural disasters in conditions of remoteness from medical institutions, rotational work method, expeditions, long sea voyages, polar wintering is also intended for students of humanitarian and technical universities studying the courses “Life Safety” and “Fundamentals of Medical Knowledge and Health Protection”, as well as those who independently master the basics of life safety.

The offered lecture and practical course were built on the one hand on the basic principles of didactics, namely: scientific character; consistency and consistency in training; links between theory and practice; consciousness, activity and independence of students; visibility; availability; strength of knowledge, abilities, skills; taking into account individual characteristics in collective educational work with the trained population, on the other - using different forms of prevention: primary, secondary and tertiary. Improper, poor quality, not a timely provision of first aid for injuries by the population in emergency situations lead to serious, sometimes life-threatening complications. The authors consider the problem of human security as a complex problem of life support of modern society. Topics covered include: Classification of emergency situations; Unified Russian state system for the prevention and elimination of emergency situations (RSChS); Natural emergencies; Industrial accidents and disasters; Accidents with the release of potent poisonous substances (SDYAV); Modern weapons of mass destruction and their impact on humans; Chemical weapon; Terrorism; Organization of civil defense and the necessary documentation in educational institutions on civil defense issues; Methodology for conducting the “Day for the Protection of Children in Emergency Situations” at school; Educational-methodical complex for the discipline “Life Safety” (for universities) [21].

Considerable attention is paid to first aid for injuries and accidents during emergencies of natural, man-made or anthropogenic origin. Topics covered: Basics of asepsis; Antiseptic and its types; Wounds. Animal and insect bites; Desmurgy. Bandage technique; Bleeding. Methods for temporary and permanent control of bleeding; Types of thermal injuries. Electrical burns. Thermal and radiation burns. Frostbite; Traumatic shock. Anti-shock measures in the focus of mass destruction and at the stages of evacuation; Fractures and their types. Absolute, relative and local signs; Head, neck and spinal column injuries; Injury to the chest and chest organs; Injury to the abdomen; Combined damage caused by weapons of mass destruction; Basic principles of resuscitation; Prevention of child and school injuries [22,23].

Both manuals have gone through four editions and recommended by the Presidium of the Council of Educational Methodological Association of Russian universities in the field of teacher education as a textbook for students of higher educational institutions, students majoring on discipline 033300 “Safety”. They were presented at the collective stand of the Universities of Russia exposition at the 55th International Book Fair in Frankfurt am Main (Germany), which after graduation entered the library of the University of Frankfurt. Largely thanks to these publications in the universities of Syktyvkar, a systematic approach to training the civilian population, represented by students of higher and secondary specialized educational institutions, for a healthy lifestyle, disease prevention and first aid in case of injuries and accidents during accidents, emergencies and natural disasters have been formed disasters [24, 25].

Practical use of educational and methodological works

The psychiatrist in co-authorship on the basis of the “Komi Republican Institute of Education” has developed courses of lectures:

1) “Self-, mutual and first (pre-medical emergency) assistance in case of injuries and accidents” (17 topics) to improve the qualifications of school teachers and educators of children’s institutions (2015);

2) “Fundamentals of the provision of pre-medical care” (15 topics) to improve the qualifications of teaching staff (2016);

3) “First aid for injuries and accidents” (15 topics) to improve the qualifications of teachers of institutions with secondary specialized education (2017);

4) Distance learning course “First aid to citizens in conditions threatening life and health” (14 topics) to improve the qualifications of teachers in schools and other children’s institutions. Training for this course has been conducted since 01.04.2017 to improve the qualifications of teachers in the system of lifelong pedagogical education on the Internet portal “Komi Republican Institute of Education” with the issuance of a certificate. More than 13.5 thousand employees of the Republic of Komi have completed and completed their training, received certificates of the established state standard. The cadets answered 80% or more of the questions correctly.

Discussion

Psychiatric education is a mandatory section of the work of every health care institution, a professional duty of every medical worker in a hospital and polyclinic. It can significantly affect: 1) Prevention of diseases (through the promotion of a healthy lifestyle); 2) Early seeking medical help (through primary prevention of certain diseases); 3) Terms of recovery (in the process of constant medical supervision); 4) The effectiveness of follow-up treatment and restoration of working capacity (rehabilitation); 5) Re-hospitalization (through the promotion of secondary prevention measures). Health education is extremely useful when it is constructive and focused on promoting a way to get better, rather than being intimidated. Its task is to teach patients to provide themselves with possible and affordable types of preventive actions, to increase the effectiveness of the available material resources and improve the quality of life. Thus, psychiatric education and education can be viewed as a type of psychological intervention aimed at achieving positive changes in the cognitive, emotional and behavioral spheres [26-30].

Education in psychiatry in all forms contributes to wider medical prevention of the development of mental pathology, as well as the improvement of already developing diseases and the prevention of relapse of cured diseases.

Despite the fact that the psychiatrist deals with such topics that are not of a pronounced psychological nature, which always include psychological problems and since relate to human relationships, provide people with information, recommendations, advice and act on them emotively. An example of “non-psychological” topics is: prevention of injuries during accidents, catastrophes, natural disasters and terrorist attacks; hygienic health education and advice on healthy lifestyles, nutrition, childcare, infection prevention. The effectiveness of health education in these areas, for example, in the field of nutrition, is due to the kind of mental contact the doctor established with the listeners, how much he is able to combine reasonable arguments with emotional and suggestive influences, how much he is able to assess the awareness of the listeners about the information offered and proceed from this. , how it is possible to grasp the attitude of the audience to the topic (interest, agreement, protest, distrust, irony), and to what extent he will manage to strengthen positive tendencies in a tactful way, and weaken or change negative ones [31-34].

Conclusions

Sanitary educational work in psychiatry is aimed at increasing the level of knowledge of the population about mental disorders, mastering methods of protection from stress, the harmful effects of bad habits. Individual health education accompanies the entire treatment process.

A psychiatrist should work with every patient who has signs of mental pathology and through the dissemination of medical and hygienic knowledge, education of sanitary and hygienic skills in order to preserve and strengthen health, improve sanitary and hygienic culture, taking into account gender, age, climatic and geographical features, national customs, traditions and other factors can affect the individual health.

During an outpatient appointment, all psychiatrists, without exception, need to conduct individual conversations on the prevention of mental illness, during which it is important to explain to patients what pathology the patient has, what kind of treatment is required and what preventive measures for mental disorders exist (psychoprophylaxis, psychohygiene).

Involvement of the patient in individual prevention and participation in the treatment of already developed pathology in psychiatry should be carried out using various forms of health education. It should be constructive and focused on promoting ways of recovery.

Psychoeducation, psychiatric education and psychoprophylaxis, carried out by a psychiatrist, teaches patients to provide themselves with possible and affordable types of preventive actions, increases the effectiveness of the use of available material resources and improves the quality of life. They are types of psychological intervention aimed at achieving positive changes in the cognitive, emotional and behavioral spheres of the sick person.

The authors declare that there are no sources of funding for this article.

The authors declare that there are no conflicts of interest to disclose in connection with the publication of this article.

The authors express their sincere love to their parents. The authors are grateful to Muratova I.D., Stepanov A.F., Ipatko I.A., Nosov O.P., Repina G.V., Mordvinkova L.V., Krasteva-Gavrilova A.G. as well as to all anonymous reviewers for their support, valuable advice and useful comments.

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