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Routledge Handbook of in Asia

Dinesh Bhugra, Samson Tse, Roger Ng, Nori Takei

Russian Federation

Publication details https://www.routledgehandbooks.com/doi/10.4324/9781315884622.ch3 Valery Krasnov, Nikolay Bokhan Published online on: 20 Aug 2015

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Buryats,Tuvinians(Dashieva andKupriyanova,2009;Rakhmazova family –whereastheothergroups speaklanguagesintheTurk,TungusticandSamodian persons), AltaitsandShorts(92,000 persons).BuryatsspeakalanguageintheMongolian Buryats (about400,000persons), TuviniansandTofalars(250,000persons),Khakas(75,000 dangerous (Bokhan,2009) of awiderangesupportivetechnology,socioeconomicdevelopment remainsuneasyandeven the nativepopulation.Attheseveryhighlatitudes,eveninmodern times,withtheavailability to theethnoculturalinvestigationofinfluenceenvironment onthementalhealthof the world,intermsofterritorialsize.Kamchatkaisrightlyregarded asaplaceuniquelysuited far eastofRussiaincludestheRepublicYakutia,whichis thelargestadministrativeunitin easterly regionofthecountry).Theseareashavedistinctive small indigenouspopulations.The of communicationamongthepeopleirrespectiveethnic origin. ‘Russian’ foranypersonspeakingRussian,whichisthestate language inRussia,andthemeans Inside Russia,however,peoplerarelymakereferencetoethnicity. Peopleabroadusethename In additionthereareverysmallgroupsofpagansinremotepartsSiberia,practisingshamanism. Buryats andTuviniansinSiberia)asmallnumberofpeoplebelongingtotheJudaicreligion. are Muslims.TherealsoBuddhistminorities(KalmyksintheEuropeanpartofRussia,and formally bedescribedasChristian;Tatars,BashkirsandmostofthepeoplefromnorthCaucasus of thetotalpopulation(500,000persons).MostRussians,UkrainiansandArmenianscan Siberia, thefareastandnorthofAsianpartRussiaconstituteabout0.3percent (1.6 million),Chechens(1.4million)andArmenians(1.1million).Theindigenouspeoplesof extremes comeTatars(5.6million),Ukrainians(2.9Bashkirs(1.7Chuvashs ethnic Russianstominoritiesnumberingonlyseveralhundredpersons.Betweenthesetwo i.e. US$23,570percapita. population asof2013was143.4million,andcountry’sGDPin2012reachedUS$3,380billion, spanning theeasternpartofEuropeandnorthernAsiatoPacificOcean.Its Khakas (Taliyanova andKorobitsina,2011) southernAltaitsarerepresentatives ofacentral- Siberia andthefareastofRussia arehometo65smallerindigenousgroups,including The northofRussiaincludesSiberia,ChukotkaandKamchatka (thelastalsobeingthemost Russia hasmorethan150ethnicgroups,whichvarygreatlyinsize,fromthe115million Valery KrasnovandNikolayBokhan Russian Federation et al. , 2012), 3 2 , Downloaded By: 10.3.98.104 At: 17:11 02 Oct 2021; For: 9781315884622, chapter3, 10.4324/9781315884622.ch3 the state’shealth carestrategy,unlikepaediatrics andcardiosurgery. problems willbeovercomein theshortterm.Untilrecently,psychiatrywasnotapriority in difficulties ofthistransitionalperiod inRussia’ssocialdevelopmentmakeitunlikelythatthese are costlyandsoremainunavailable tomanypatients,especiallyoutpatients.Economic of spaceandequipment)raiseserious ethicalandlegalissues.Moreover,manyeffectiveremedies outpatient . care ofavisitingspecialistfromlocaldispensary.‘Dispensary’ isthetraditionalnameforan (without activetherapy)orliveathomeundertheinformalcare oftheirrelativesandtheformal in facteitherinpatientsofspecializedinstitutions(‘internats’) forthechronicallymentallyill jobs forthem(only3.3percent).Whilemanyappeartolive onthestreets,mostofthemare to amentaldisorderwas1,033,308in2011(Gurovich,2012); andtherearefewsheltered adaptation inthesettingofamarketeconomy.Thenumber ofpeopleregistereddisableddue public healthsystemstrugglestoprovidementallyillpeople withsuitableemploymentand in extramuralformsofpsychiatriccare. the decreaseinnumberofpsychiatricbedshasnotalwaysbeencombinedwithanincrease the numberofpsychiatricbedsper1,000populationis1.02andstillcontinuingtofall.However, by 25percent:from200,192bedsin1991to146,4272012(seeTable3.1).NowRussia havemorethan1,500beds.Inthepast20yearstotalnumberofbedshasdecreased centralization. Themajorityofpsychiatrichospitalshavemorethan500bedsandseverallarge regional levels,buttheprovisionofsocialcareisinadequate. course ofpsychiatrictreatment.Ithasbeensuccessfullyimplementedatbothfederaland It considerablywidenedpatients’rightsandrestrictedthepossibilityofunlawfulactionsin 1993). TheRussianlawguaranteescitizens’rightsandwascommendedbyinternationalexperts. Soviet republicstopassalawonpsychiatriccare,in1992(itcameintooperationJanuary against officialpsychiatry,aswellafearofstigmatization. payments withinprivateandcommercialservices,partlybecauseofastrongpopularprejudice of chargeforpeoplewithmentaldisordersbutmanynonethelessmakeout-of-pocket (Popovich According toWHO,totalhealthexpenditureinRussiarepresents5.2percentofGDP Mental healthpolicy . parameters thatmaytestifytotheseobjectiveprocesses.Theyhavehighratesofalcoholand inevitable (Gumilev,1993),butmedicineandpsychologyassumemeasurementofcertain there isintheseregionsatrendtowardsdepopulation,whichsometimesviewedasbeing discrimination orprejudiceamongthem;indeed,therearemanymixedfamilies.However, sphere. Theyhavelivedtogetherformanyyearsinthesameterritoryandthereisnoovert experiencing asimilarprocessofacculturationthataffectsthephysiologicalaswellsocial Caucasian populationofSiberia. to asouth-Siberiantypeformedasmixtureofcentral-AsianMongoloidsandtheancient Asian typeof‘Mongoloid’ethnicity.Shorts,northernAltaitsandsomegroupsKhakasbelong The unfavourablelivingconditions inmanypsychiatricclinics(roomswithbeds,lack The taskofrebuildingthelargehospitalsremains,buteconomic difficultieshinderthis.The A specificfeatureandprincipaldefectofinpatientpsychiatriccareinRussiaisitsover- After thedisaggregationofSovietUnionin1991,Russiawasfirstformer Despite differencesincultureandanthropomorphologicaltraits,thesegroupsareall et al ., 2011);thisislowerthaninotherEuropeancountries.Careprovidedfree Russian Federation 19 Downloaded By: 10.3.98.104 At: 17:11 02 Oct 2021; For: 9781315884622, chapter3, 10.4324/9781315884622.ch3 of alternativeformscareis also required. (Krasnov, 2008).Theneedhas arisen toreformoutpatientpsychiatriccare,andthedevelopment In addition,approximately25–30 percentofprimary-carepatientsneedpsychiatricconsultations disorders registeredinpsychiatric institutionsreached2,951.1per100,000populationin2011. mentally illpatientsapplyforpsychiatricassistanceinadispensary. Theprevalenceofmental left thepublicsectortoworkinprivatepractice(Table3.2).Onlyabout30–35percentofall development ofpsychiatricdispensaries.Manypsychiatrists, especiallypsychotherapists,have stigma andsocietalprejudicesagainstpsychiatrypsychiatric institutionshinderthe public andconnectedtolocalpsychiatrichospitalsisapractical expedient.Ontheotherhand, provision ofpsychiatriccarethroughlocaldispensaries thatareopentothegeneral (Table 3.1).Ontheonehand,takingintoaccountshortagesinstate budgetallocations,the oilwres801871,606 1,857 911 3,568 840 772 2012 13,287 3,050 1,717 16,184 2008 70 1,407 15,860 5,457 3,438 1999 11 Clinical (workingin 224 5,012 3,248 Social workers (with highereducation) 12 Specialists insocialwork 4,470 257 ) 24,250 people sufferingfromalcoholandother Narcologists (specialistsrenderingcarefor 13 2012 (including psychotherapists) 102 26,550 278 (13,915) 146,427 Specialists 101 28,700 2008 830 Table 3.2 145 (13,890) 155,834 170 (14,015) a 144 1999 170,440 1,107 164 Number ofbedsinnarcologicalhospitals (including psychiatricbedsingeneralhospitals) 123 Total numberofbedsinpsychiatrichospitals 171 1,118 Narcological hospitals Psychiatric hospitals 122 Psychotherapeutic unitsingeneraloutpatient and drugaddicts) Narcological dispensaries(foralcoholics Dispensary departmentsinpsychiatrichospitals Psychiatric dispensaries Institutions Table 3.1 Valery Krasnov,NikolayBokhan 20 psychiatric andnarcologicalinstitutions) Current statisticaldatahasbeentakenfromthewebsiteofMinistryPublicHealthRussianFederation The wholesystemofpsychiatriccarehasshowncontradictory tendenciesinitsdevelopment Specialists renderingpsychiatriccareinRussia Resources availableforadministrationofpsychiatriccareinRussia a Downloaded By: 10.3.98.104 At: 17:11 02 Oct 2021; For: 9781315884622, chapter3, 10.4324/9781315884622.ch3 3Ubksa . . . 2005 2002 2012 2009 2012 2010 4.3 19.7 2012 19.8 8.8 20.1 20.8 2012 1.7 21.7 3.6 21.7 7.0 14.1 9.24 Uzbekistan 34.8 Kyrgyzstan 73 Year Croatia 51 Ukraine . Russia 14 Average Latvia 13 SriLanka 13 Japan 12 Female 11 10 Male Country Rank Table 3.3 social modelofmentalhealthcareandateamapproachtoitsprovision(seealsoTable3.1). the staffofpsychiatricinstitutions,tosupportatransitionfromlargelymedicalbio care. Firstofall,asignificantnumberpsychologistsandsocialworkershavebeenaddedto Several importantchangeshavebeenmadeinthelastdecadedevelopmentofpsychiatric Reforms inpsychiatriccare . per 100,000ofpopulationin2012;amongthese,opioiddependenceisthedominantform in prevalenceoverrecentyears,fromatotalof252.2per100,000population2008to382 per 100,000population.Themale/femaleratiois5:1.Otheraddictionsappeartohaveincreased (Nemtsov, 2011). Russia istheequivalentofapproximately14–15litresspirit(primarilyvodka)percapita of alcoholconsumptionamongmen.Acrossthewholepopulation,in rate amongmenissixtimeshigherthanwomen,probablybecauseofthe 3.3). Overthelasttwodecades,though,ithasdecreasedsubstantially,from38.7in1999.The rate was20.1per100,000in2012.Thisisoneofthehighestnationalratesworld(Table predominantly ruralMuslimpopulation,asIslamprohibitssuicide.TheRussiannationalaverage rate is0.8per100,000andinDagestanit2.8.Thisduetothetraditionalcultureof it is64.0. Republic therateis67.3per100,000,inNenetsAutonomousDistrictit64.1andBuryatia statisticsvarywidelybyregionwithinRussia.Siberiahasthehighestrate.InAltay Suicide andsubstanceabuse eau 052012 2009 2011 2011 20.5 22.23 21.7 2008 21.8 2006 2013 2012 8.5 25.6 26.4 9.4 2011 28.0 31.0 37.4 9.4 13.4 34.6 83.0 18.0 10.8 39.0 43.0 45.0 Hungary 38.2 54.7 Slovenia Belarus 9 116.9 China 8. Kazakhstan 7 Guyana 6 SouthKorea 5 Lithuania 4 Greenland 3 2 1 The prevalenceofalcoholismhasbeenmoreorlessstableoverlastdecade,ataround1,792.5 The lowestratesofsuicideareseeninthenorthCaucasus.InChechenRepublic Suicide ratesper100,000bycountry,yearandsex(WHO,2012,data) Russian Federation psycho 21 - Downloaded By: 10.3.98.104 At: 17:11 02 Oct 2021; For: 9781315884622, chapter3, 10.4324/9781315884622.ch3 gations (Nikitin,2007) use byCaucasianslivinginthesameregion,asshownlong-termepidemiologicalinvesti problem. AlcoholuseamongtheindigenousinhabitantsofsouthernSiberiaexceedsalcohol psychiatry, psychologyandpsychotherapyarerequired.Inparticular,alcoholaddictionisa role ofpsychologicalissues,,religion,mythology,traditionsandcustoms.Addiction requires thedevelopmentofcross-culturalpsychiatry,withanintegratedunderstanding and Gurovich,2012). but arenowincreasinglyengagedinmentalhealthprovision(Gurovich,2005,2012;Krasnov and psychosocialworkwithfamilies–isnowprovided.NGOsarenotyetsufficientlyinvolved facilitated. Assertivetreatmentteamshavebeensetupand‘hospitalathome’–psychoeducation types ofprotectedhousinghavebeenestablished,andinteractionwithsocialserviceshas organized. Inaddition,specialclinicsforpeopleinafirstepisodeofpsychosis,hostelsandother the developmentofcareincommunity,whereasystempsychosocialrehabilitationis history ofalcoholismaretypical (Bokhan a withdrawalsyndrome,actsof brutalitywhileintoxicated,acceptanceoftherapyandafamily in menwereashigh36.9per cent,andinwomen20.3percent.Quicknessofformation of (Rakhmazova (up to60.8percentofthoseexamined)andneuroticdisorders inwomen(21.1percent) of remotedistrictsBuryatiya,highratesalcoholdependence werefoundinmaleBuryats In aclinical/epidemiologicalinvestigation(DashiyevaandKupriyanova, 2009)ofthepopulation Mongoloids andabout660,000ethnicRussiansliveinBuryatiya (othergroupsaremuchsmaller). family/tribal groups.Currentlymorethan270,000Buryats couldbeclassifiedascontinental frequency ofmentalpathologyintheBuryatMongol population differswidelyacross low ratesofalcoholpsychosesandaprevalencefemale .Interestingly,the Arctic Mongoloidsarecharacterizedbyanabsenceofvegetative signsofabstinencefromalcohol, Buryats (continentalMongoloids),explosivenessinastateof alcoholintoxicationiscommon. psychoses, whichisculturallyconditionedbytheirrespectfulattitude towardstheelderly.Among types ofdisorder.Forinstance,TuviniansandBuryatsarehighly tolerantofpersonswithsenile modernization’. the circumpolarpopulations)havebeengreatlyinfluencedbyacculturation,or‘stressof autonomy. of southernSiberiahavemaintainedtheirtraditionalcultureandadministrativeterritorial Russia. limited locallabourresourcesandthelarge-scaleimmigrationofworkersfromelsewherein territories, representriskfactorsforthedevelopmentofmentaldisorders.Thisiscombinedwith industrial complexeswithinthehigh-temposocioeconomicdevelopmentoffarnorthern isolation andremotenessofvillages,neverthelessaccompaniedbythedevelopmentlarge extremeclimate,andlongdarkwinters,combinedwiththelowdensityofpopulation The Geographic andethnicpatternsofmentalhealth Valery Krasnov,NikolayBokhan 22 . Dependence onmorethanone substancewasatriggerfortheformationofchild/adolescent The problemofmentalhealthcareforindigenouspopulationsinSiberiaandthenorth Second, thestructureofmentalhealthservicehaschanged,withagreateremphasison Ethnocultural factorscaninfluencetheclinicalmanifestationandmanagementofvarious The qualityoflifeandmentalhealththesmallerethnicgroupsRussia(andespecially Despite theirhistoricalandenduringcontactwithSlavs,mostoftheindigenousinhabitants et al ., 2012).InPrimorskyKrai,among UdegeansandNanaitsratesofaddiction et al. , 2006;Badyrgyetal.,2012;Artemyev, 2012). - Downloaded By: 10.3.98.104 At: 17:11 02 Oct 2021; For: 9781315884622, chapter3, 10.4324/9781315884622.ch3 biopsychosocial paradigmand sociotherapeutic preventivemeasures. represents animportanttheoreticalstimulusconnected withthecrystallizationofa strive nottoviolatehumanrights.Theelaborationofcross-cultural aspectsofpersonalitydisorder and socioculturalinterventionsarerequired,oneswhichhave aflexiblestructureandwhich In thedevelopmentofpreventiveactivitiesbyhealthcareagencies, acomplexofmedico-social and addictivedisordershavebecomeallthemoreevident(Bokhan andOvchinnikov,2014). ‘risk groups’,pre-morbidstates,and,forinstance,prognostic criteriaforborderlinepersonality of acceptanceICD-11,thetheoreticalsignificanceandpractical valueofdistinguishingdifferent help areneededbytheindigenouspopulationsofeastern region ofRussia.Onthethreshold addiction psychiatryservices.Newformsofpsychiatric,psychological andpsychotherapeutic rates ofalcoholism. (Semke andBokhan,2008).Thekeymaybetounderstandtheproblemoftheirheightened and thegreatestratesofresistancetotreatmenthavebeenobservedinnativeArcticpopulation notably withbrutalbehaviour,havebeennoted.Thegreatestratesofprogressiontoalcoholism early developmentofamnesicformsintoxicationandalcohol-relatedpersonalitychanges, specific groups,especiallyMongoloidpeoples.Lowtolerance,earlylossofsituationalcontrol, their religiousframeworks. the basicdelusionalstorypersists,perhapsbecauseofpatients’beliefsinitscorrectnesswithin character oftenthemselvesattributedtotheviolationofataboo. spectrum disordersinBuryatsarecharacterizedbythepresenceofcomplaintsasomatic who doesaidrecoveryfrommentaldisordersinsomelocalareaseastRussia).Depressive themselves tobealamaorshaman(Shaman[ concern ideasofsupernaturalabilitiesclairvoyanceandhealingpowers,patientsimagining can reflectreligiousbeliefs:shamanism,Lamaism,Buddhism.Thus,themostfrequentdelusions andthecontentofmentaldisturbances–delusionshallucinationsinBuryats living inSiberiaandsomeofthesmallindigenousminorities.Forinstance,presentation of eachthistriadfactorstomentaldisordersvaries. under specificconditionsandneedsdistinctethnoculturalinvestigation.Thecontributions weight andsignificanceofthistriadisassociatedwiththepeculiaritiespopulationsliving individual/biological (biochemical,genetic,constitutional,morphological).Theparticular important roleofthreebasicfactorsintheaetiologythesediseases:social,psychologicaland concept ofmentaldisordersappearstobemoregenerallyapplicable.Thissupposesan 2009). of anumberaffectiveandaddictivestates(SemkeBokhan,2008;SemkeChukhrova, studied; nevertheless,thesegroupsdoappeartobevulnerablesocialstressandtheformation Baykal andsouth-Siberiantypes,havebeendescribedrepeatedlybuttheyremaininsufficiently Mongoloids (RepublicsofSakha/Yakutia,Buryatiya,Tyva),aswellamong clinical–organizational studiesasthemainscientific taskintheirwork., thetesting As thereisanurgentneedforreforms inmentalhealthcare,Russianpsychiatristsregardapplied Research activityinthe mental healthsphere Thus, formodernRussiaapriorityisthedevelopmentof cross-culturalpsychiatryand In Russia,anareaofurgentresearchinterestisthechoicesubstancesabuseamong Psychopharmacological therapyincasesofculture-bounddelusionisusuallyinsufficient,and There aresomedifferencesinthesymptomsofmentaldisordersamongCaucasianpeople Among themoremixedpopulationstypicalofeast-AsianpartRussia,multifactorial High ratesofneuropsychiatricdisordersandalcoholismamongnorth-AsianArctic шаман ] –amediatorcommunicatingwithspirits, Russian Federation 23 Downloaded By: 10.3.98.104 At: 17:11 02 Oct 2021; For: 9781315884622, chapter3, 10.4324/9781315884622.ch3 Tomsk (Semke of Russia.Indeed,alltheseissuesarebeingstudiedattheschoolcross-culturalpsychiatryin mental healthconsequencesforethnicgroupsoftheindustrializationsomeremoteregions aspects ofthepreventionmentalandbehaviouraldisordersindifferentsocialgroups; psychological investigationsofmentaldisordersindifferentethnicpopulations;ethnocultural east andfarnorth;thebiological,molecular-genetic,neurophysiologicalexperimental- preven social indicesandsubstanceabuse;thepredictorsofformation,clinicaldynamics genic andextremegeographicfactors(principallylongwinternightsinthefarnorth);medico- and schizophreniformdisorders;thecontributionofmigration,acculturationstress,anthropo differences; problemsofcomorbidity;therapeuticresistanceinaddictive,borderline,affective age andsocialgroups;theethnoculturalassessmentofsuicidalaggressivebehaviour;gender prevention ofmentaldisorders(includingaddictionsandpsychosomaticdisorders)acrossdifferent population: theepidemiology,pathogenesis,phenomenology,clinicalassessment,diagnosisand a multidisciplinaryfocusontheethnicorterritorialparametersofmentalhealth Bokhan such asecologicalandethnoculturalpsychiatry(Semke some regions.Recently,newbranchesofresearchandclinicalpsychiatryhaveemergedinRussia, development ofappropriatementalhealthcareinterventions(IdrissovandKrasnov,2009). during periodsofreconstructionandreconciliation,asintheChechenRepublic,hasledto health ofpopulationslivingforalongtimeunderthestrainstateemergency,andeven supported byaspecialfederalprogramme(2007–2011).Inparticularregions,studyofthemental and otherspecialists(Krasnov,2008,2011).Sociallyorientedstudieshaveinrecentyearsbeen of workingrelationshipsandjointresearchwithgeneralpractitioners,cardiologists,neurologists primary carearealsoanimportantfocusofscientificandpracticaleffort,asoptimalforms (Gurovich, 2005,2012).Therecognitionandtreatmentofdepressiveanxietydisorderswithin rehabilitation, andinvolvementofNGOsareprioritiesformostresearchersresearchgroups of newmodelstreatment,especiallymultidisciplinaryteamworkapproachestotreatmentand Valery Krasnov,NikolayBokhan 24 psychological training inBuddhismmight serveasabasisfortheelaboration ofnew for prevention,andtreatment andrehabilitationwithinmentalhealthcare.Inthisrespect, aspects ofprofessionalethnocultural competence,wouldhelpintheelaborationofstrategies the religiousnotionstypicalof Buddhismandshamanism,say,thedevelopmentofother addiction, whereanacquaintance atleast,onthepartofpsychiatristsandpsychologists,with key regards.Forinstance,there isnospecialtrainingcourseincross-culturalpsychiatry and conditions acrossRussia’shugeterritory,thesystemofpsychiatric educationislackingincertain variety oftrainingschemesforclinicalpsychologistsandsocial workers. professional statusincertificateconfirmationcourses,once every fiveyears.Therearealsoa psychosomatics andtheorganizationofpsychiatricservices. Alldoctorshavetovalidatetheir of practicalworkinpsychiatry).Therearealsocourseson psychogeriatrics, childpsychiatry, psychiatry, narcologyorpsychotherapy(psychotherapyispossible onlyafteratleastthreeyears an additionaltwo-yearcoursetermed‘ordinature’andthen500 hoursofspecializationinforensic Postgraduate educationforclinicalpractice(aftersixyearsofformal medicaleducation)comprises Education inpsychiatry Further developmentofthescientificbasismentalhealthcareinRussiaislikelytohave Russia’s multi-ethnicpopulationpresentsspecificproblemsinrelationtopsychiatriccare But, takingintoconsiderationthewidedifferencesinsocioeconomic andsociocultural tion ofaddictivestatesamongindigenousandsmallerethnicgroupsinSiberia,thefar et al ., 2013). et al. ,1999; SemkeandBokhan,2008;BokhanOvchinnikov,2014). et al ., 1999;SemkeandBokhan,2008; - Downloaded By: 10.3.98.104 At: 17:11 02 Oct 2021; For: 9781315884622, chapter3, 10.4324/9781315884622.ch3 Dashiyeva, B.andKupriyanova, I. (2009)‘Factorsinfluencingonmentalhealthstateofschoolchildren Bokhan, N.A.,Mandel,A.I.,Aslanbekova, N.V.andPeshkovskaya,A.G.(2013)‘Ethnoterritorial Bokhan, N.A.andOvchinnikov,(2014) Bokhan, N.(2009)‘Clinical-ethnoculturalpeculiaritiesofalcoholism amongtheaboriginalpopulationof Badyrgy, I.O.,Bokhan,N.A.,Mandel,A.I.,Mongush,Ch.K.and Peshkovskaya,A.G.(2012)‘Medico- Bokhan, N.A.,Mandel,A.I.and Gusamov,R.(2006)‘Mentalandbehavioraldisordersinsubstance Artemyev, I.A.(2012)‘Alcoholisminpolyethnicsubpopulationsof thecircumpolarzoneofnorth-eastern Bibliography values. individual throughtheprismofnationaltraditionsandcustoms,butincorporatinguniversal of psychiatrichelpinRussianeedsasystemicanalysisthe‘inner’and‘outer’space and therebyindirectlydetermineindividualsocietalwell-being.Theeffectiveorganization has itsownsocialandethniccharacteristics,whichdetermine,forexample,responsestostress, structure andcontentofthemicrosocialmacrosocialenvironment:eachsocietalstratum immigrant labour.Undertheseconditionsthementalhealthofpopulationdependson its easternregions,withtheirmultiethnicpopulationsandmulticulturallifestyles,combined of personality,neuroticandaddictivedisorders,haveparticularrelevanceinRussia,especially assessment ofthepsychogenicfactorsunderlyingmostcommonpsychopathologicaldisorders shamanism willhelpintheelaborationofpreventiveandtreatmentprogrammes. the partofpsychiatristsandpsychologistsreligiousnotionstypicalBuddhism will helptomeettheethicalnormsofpsychiatry,psychologyandprevention.Awarenesson Buryats. Thedevelopmentofpersonalizedmedicinewithinacross-culturalpsychiatricapproach methods oftreatment,necessaryforthetreatmentculture-boundmentaldisordersamong with modernpsychopharmacologicalapproaches,considerableemphasisisgiventotraditional more comprehensivebiopsychosocialmodelofcarewithmultidisciplinaryworking. psychosocial approachesinmentalhealthcareandthetransitionfrommedicalmodeltoa regional programmesfortheimprovementofpsychiatriccare,especiallydevelopment are generallygivenprimacy).Somementalhealthproblemsbeingsolvedwiththehelpof financial difficultiesandaconflictofpriorities(areassuchascardiology,oncologypaediatrics institutions. Severalattemptstoestablishsuchaprogrammeinpreviousyearsfailedbecauseof did helptodevelopsomeprojectsinpsychiatry,andimproveconditionsmanypsychiatric In 2007–2012theFederalProgrammeofEmergencyMeasuresinSociallyImportantDiseases Conclusion withculture-bounddisorders. psychotherapeutic methodsoftreatmentfortheindigenouspopulationSiberia,especially from Buryatrural population’. Nevrologii andPsikhiatriiImeniSS Korsakova heterogeneity offormationalcohol dependenceinthenativepopulationofSiberia’. Kamchatka’. and AddictionPsychiatry. social indicesofthedrugsituationamongpopulationRepublic of Tyva’. use amongadolescentsunderconditions ofthefarnorth’. USA: PublishingHouseScienceandInnovationCenter. regions ofRussia’. Modern Russiaischaracterizedbydynamismandinstability.Socialpsychiatrythe In programmesforthepreventionofdependenceinindigenouspopulationsSiberia,along World CulturalPsychiatryReview. Siberian HeraldofPsychiatryandAddictionPsychiatry. 72: 29–32(inRussian). 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