Evidence based medicine at the beginning of XXI century

V.V.Vlasov

Medicine is a social practice helping people in suffering connected with diseases. The evidence based medicine is a form of medical practice guided by methods and data proved by high quality scientific research. As such proof serves only randomized and controlled trails, relying on its survey, first of all research registered before standing it for minimization all kind of falsification. Medical care should be oriented to useful aim – longevity and quality of life, but not to normalization of various instrumental indices. This is exactly patient-oriented approach in medicine. Qualified medical care depends largely on situation in society.

Key words: evidence based medicine in psychiatry

Necessity of various forms of dialogue between clinical and inductive methods

Yu.S.Savenko

Regardless of clearly evident mistake of contraposition of strictly scientific inductive methodology to clinico-phenomenological one, once again are being repeated attempts of discredit and ousting of clinical method by questionnaires, forms and scales and clinical analysis by simple confronting with a sum of symptoms and qualification of syndrome and nosology by constructing clasters and so on. But integration of these methods, their mixing is also a wrong ineffective way.

Contemporary evidence based medicine is designed for medical somatology, while bio-social model is conformable to psychiatry. The protest of doctors-psychiatrists is directed not against the evidence based medicine, but attempts of discredit and ousting of the clinical method. Both trends are necessary, but their practical use is still very imperfect. They shroud not be integrated, but combined in various forms in accordance with concrete tasks.

Various forms of “dialogue” of these methods are necessary. And here conception of a ”dialogue” is greater than a metaphor.

Key words: evidence based medicine in psychiatry, integration of methods

Issues of diagnosis of autism in adults and children

B.V.Voronkov, L.P.Rubina

The article presents a historical and contemporary aspect of relationships between concepts of “autism” and “autistic thinking”, analyzes the role of intuition in the diagnostic process and the consequences of the revision by researchers concept of autism. This revision, along with several other factors led to overdiagnosis of infantile autism.

Key words: autism, autistic thinking, autistic existence, infantile autism, disorders of autistic spectrum, phantom psychiatry.

Infrastructure the constructs of stigma in anxiety-depression spectrum disorders

I.E.Sekoyan, A.P.Gevorkyan, E.S.Sekoyan

Stigmatization peculiarities of patients with in anxiety-depression spectrum disorders (Montgomery-Asberg Depression Rating Scale, Beck Depression Inventory, Spielberger State-Trait Anxiety Inventory) are revealed by means of the standartised scales on estimation of stigma indicators in persons with mental diseases (Sigma Scale, Internalised Stigma of Mental Illness, Self-stigma of Mental Illness Scale). An integrated quantitative estimation of stigma, quantitative characteristics of infrastructure and intracorrelation of stigma components (discrimination, disclosure, positive aspects), stigma internalizations (alienation, stereotype, discrimination social withdrawal, stigma resistance) and its social mediators – self-esteem (Rosenberg Self-Esteem Scale), self-efficacy (Sherer Self-Efficacy Scale) are given by means of the multidimensional analysis. Characteristics of interrelations between various elements of Self-stigma (awareness, agreement, application, hurts self)) is presented, positive correlation of stigma with depression, reactive and personal anxiety is found out. There is formulated a position that in internalization of stigma mechanisms in mental disorders, the specificity of infrastructure and interrelations of stigma construct are in dependence from the level of nonspecific elements – social mediators and modulating factor – symptom and/or syndrome of mental disorder. Obtained data dictate the necessity to develop new approaches and methods of differentiated destigmatization of patients taking into account peculiarities of interrelations of stigma construct elements.

Key words: stigma, stigma internalizations Self-stigma, depression, anxiety

On ambulatory therapy by means of creative self-expression (M.Burno) in psycho-social rehabilitation of shift-like schizophrenia patients (longstanding experience).

M.E. Burno

The author believes that the method worked out by him and his followers (not art therapy) used for the mentioned patients (also in its short and more simple forms) helps them rather much to acquire creative inspiration, activity, their own socially useful path and even their way – as far as all this is possible for them. Ordinary psychotherapeutic techniques usually are not good for such patients as the author thinks.

Key words: paranoid (shift-like) schizophrenia; therapy by means of creative self-expression (M. Burno); psycho-social rehabilitation in psychiatry.

Can military card contain medical confidential information?

Yu.N.Argunova

On the basis of analysis of the legislation and judicial practice the conclusion has been made about incompatibility of compiling military cards with requirements of legislation on medical confidentiality.

Key words: medical secret, filling military card

Summing up of Mikhail Kosenko’s case

Yu.S.Savenko

During 10 years since Yury Budanov’s case the steady tendency of resurrection of Soviet spirit of forensic psychiatry so evidently revealed in the case of Mikhail Kosenko has been continued. The case of Mikhail Kosenko has served as a thermometer of inner political atmosphere.