Modern psychiatry is experiencing ...

Modern psychiatry is experiencing a phase of reforms aimed at democratization aid, ensuring its accessibility and the approach to the public. However, the reform of psychiatric care can not only within existing mental health services. Clear need to interact with the overall health system, particularly in the form of the integration of individual forms of psychiatric care, primary care network, primarily in the territorial polyclinics. In Russia, a traditional system of territorial polyclinic services to the population represents a significant potential for the development of mental health care and proximity to population, in particular, with nonpsychotic, moderate and brief mental health problems. Attention of specialists and health care are increasingly attracted to mental disorders, concomitant somatic diseases and conditions detected in the somatic institutions. The frequency of combinations of somatic and psychiatric disorders commonly known fact in clinical practice, is also supported by numerous special studies. Mental disorders are: to provoke somatic disease or, more often, their aggravation; exacerbate their course, delay recovery and, therefore, prolongs hospitalization [13]. In particular, the presence of depression in patients with coronary heart disease is not only a complicating factor in treatment and rehabilitation, but also reduces the life expectancy of patients [8]. On the other hand, mental disorders can themselves be a consequence of physical illness and because psychologically understandable reaction to the disease and related activity limitations, and because of the possible metabolic changes or intoxication with severe somatic pathology. In some cases cause-effect relations and primary or secondary mental and somatic diseases remain problematic and require the collaboration of psychiatrists and internists. In a specially prepared by the World Health Organization Manual of Mental Disorders in Medical Practice [3] presented a rather long list of mental disorders in respect of which involves not only diagnosis but also some of the experts lechebnoprofilakticheskie primary care network (Table 1). As can be seen from Table 1, is a common mental illness like schizophrenia, is not mentioned in the list, or more precisely, schizophrenia included not executed the category of "chronic mental disorder" or it can be assumed in acute psychotic disorders. This is due to the complexity of diagnosis and therapy, especially, no doubt requiring the participation of a psychiatrist. Here should be attached and bipolar (manic-depressive) disorder, which should also remain within the purview of mental health professionals. With regard to delirium and dementia, these disorders are often detected just in terms of somatic agencies and require awareness of internists about their displays for the timely provision of specialized care, including if necessary, transfer to a psychiatric hospital.