The Ministry of Health has developed a standard of medical care for patients with post-traumatic stress disorder
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The Ministry of Health has developed a standard for medical care for patients with post-traumatic stress disorder (PTSD). Doctors point out that participants in hostilities, as well as residents of nearby territories, doctors, volunteers, and refugees are at risk of developing PTSD. Patients, whose treatment period can be up to a year, will be offered to participate in group and individual psychotherapy, as well as to be treated with aromatic baths, healing showers, “climate exposure”, air and sun. Experts note the importance of the document, but point out the need to refine it “taking into account current clinical practice, international experience and the involvement of the domestic research community.”
The Ministry of Health developed a draft order on the approval of the standard of care for adults with PTSD based on clinical recommendations that appeared in February. Prior to this, there were no relevant recommendations and a standard of assistance in the Russian Federation. As the director of the National Research Center for Psychiatry and Neurology named after V.I. V. M. Bekhterev of the Ministry of Health of the Russian Federation Nikolai Neznanov, doctors in working with such patients relied on other regulatory documents – clinical guidelines for anxiety, panic disorders, standards for providing care to patients with a group of neurotic, stress-related and somatoform disorders. Clinical guidelines adopted by the professional community (in this case, the Russian Society of Psychiatrists) determine the strategy and tactics of therapy. The standards specify how the process should be organized. Thus, according to the draft order, the average duration of treatment for PTSD will be 325 days. Patients will be able to receive assistance in a round-the-clock and day hospital, as well as on an outpatient basis. According to forecasts of the department, 90% of patients with PTSD will need to consult a psychologist, then a third of them (33%) will be referred to a psychiatrist, and the same number to a psychotherapist. Almost half of the patients (41%) will need a daily examination by a psychiatrist with observation in the hospital for two months.
The Ministry of Health provides a list of recommended antidepressants and studies (transcranial scanning of arteries and veins, ECG, electroencephalography, and MRI of the brain). It is mandatory to check the blood for hormones, take general and biochemical blood tests and a general urine test. And as a non-drug treatment, the department recommends clinical and psychological counseling, group and individual psychotherapy, as well as treatment with aromatic baths, a healing shower, “climate exposure”, air exposure (air baths) and heliotherapy (sun therapy).
From 2022, the Ministry of Health is expanding the availability of mental health care, in particular, help for PTSD. Thus, the department has developed programs for the professional retraining of doctors in the specialties “psychiatry” and “psychotherapy”. “Narrow” specialists – therapists, pediatricians, cardiologists, endocrinologists – this will take only about five months. In addition, a system has been created for psychiatric screening of servicemen returning from the special military operation (SVO) zone: they will undergo an express test by psychologists to identify early symptoms of PTSD, and if they are detected, they will be sent for treatment to psychiatrists. In addition to participants in hostilities, residents of the territories where they are fought, doctors, volunteers and refugees can be at risk for developing PTSD.
Associate Professor of the Department of Psychiatry at RUDN University Roman Suleymanov says that even very short-term, but powerful psychotraumatic stressors can cause PTSD symptoms and generate comorbid conditions and associated behavioral symptoms. It can be chronic anxiety and recurrent depressive disorder, irritability, aggression, suicidality and impulsivity, increased consumption of alcohol and other psychoactive substances. Given the chronic nature, massiveness and polymorphism of mental disorders, the high incidence of comorbidities, as well as the abundance of protracted social and economic consequences of PTSD, the duration of psychotherapy, according to Mr. Suleymanov, can take from several months to several years, and the number of sessions starts from 10-15 (short-term therapy). In global practice, in addition to psychotherapy, as well as in case of unwillingness or inability of the patient to participate in psychotherapeutic treatment, preference is given to long-term (at least six months) therapy with the use of antidepressants: selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs). ), as well as second-generation antipsychotics. “SSRIs are being evaluated as first choice drugs for PTSD. However, the standard of medical care proposed by the Ministry of Health includes only two not the most effective and two first-generation antipsychotics. The compilers of the standard give a clear preference for tranquilizers, and six of them are benzodiazepines. Although the treatment of PTSD with benzodiazepines is not recommended in current international studies, especially in patients with substance abuse disorders,” says Roman Suleymanov. In his opinion, the PTSD treatment algorithm should be corrected taking into account current clinical practice, international experience and involvement of the domestic research community.
Elena Burdelova, a psychotherapist at the Doctis telemedicine service, notes that the list includes “not the newest, but well-known and proven” antidepressants. “The great news,” she says, is that the document focuses on psychotherapeutic assistance and group therapy: “Let it be only 12 hours for now, but this is already very important, since the main treatment for PTSD is psychotherapeutic. The effectiveness of physiotherapy and aromatic baths, probably, is – they help to relax, relieve tension – but it has not been scientifically proven.
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