Introduction. This article presents a review of current concepts of gender identity under normal and pathological conditions. Aim. To analyse the impact of the medical and social paradigm shift for clinical practice. Results and discussion. The modern academic literature devoted to gender identity disorders is characterized by a variety of terminology, a shift in emphasis from clinical judgement to a socially beneficial normocentric approach and a relatively few advanced, evidence-based research. There is also a lack of evidence for the gender theory underlying the new approach, which raises serious doubts about the validity of the medical and social paradigm revision. In the same time, the position of Russian psychiatrists remains to be more clinically oriented. Conclusion. Patients who declare the desire to reassign their gender have to be assessed by psychiatrists for differential diagnosis to exclude a mental disorder. In such cases, the destigmatization of mental disorders is more critical than the depathologization of gender identity disorders.
Today, psychiatric care for people with transgender people in the Russian Federation is difficult due to non-compliance with ethical principles in the work of the psychiatric service. The article deals with the unresolved ethical conflict regarding gender reassignment procedures between proponents of "not allowed, forbidden" with the attitude of psychiatrists to issue permission for sex reassignment only to "real" transsexuals, and supporters of the opposite liberal attitude towards issuing permission. for gender reassignment procedures for almost all applicants. Our article discusses ethical issues to help transgender people. The ethical principles of autonomy, harmlessness and beneficence in this article are intended to help transgender people. The authors ethically write about adding and not adding a transgender diagnosis to the International Classification of Diseases. This article raises concerns about the benefits and harms, the principle of respect for autonomy and the principle of beneficence, in order to provide good quality ethical care for transgender people. The authors discuss the problem of the ethical attitude of a psychiatrist to the mental health of transgender subjects. The authors discuss the ethical problem of the psychiatrist's attitude to the mental health of transgender subjects, medicalization and medical paternalism with the help of transgender people. This article raises considerations about the ethical role of the psychiatrist in gender reassignment procedures for subjects with varying degrees of mental health. The authors propose an algorithm for providing psychiatric care to persons who have undergone gender reassignment, which includes an in-depth examination by psychiatrists, psychologists, sexologists and a collegial conclusion on the state of mental health of a transgender person in the triad: mentally healthy or "have mental disorders", "borderline" or "mental psychotic disorders".
Dualdiagnosis"refers to patientswho sufferfroma substance disorder with a coexistingmentaldisorder. In Switzerland. there was a nationwidelackof medicaland ps)'Chosocial care for this increasing group of patients. A Unit at the Ps)'Chiatric Services of the University of Berne was opened 4 years ago whereinpatient treatmentconsidered both disorders and acts as a transit betweencrisisintervention units and rehabilitation programmes. Researchconcentrateson the development,descriptionand evaluationof inpatient treatment. A comparisonbetweenthe assessments at the beginning and after one year of treatment demonstratedthat psychopathology (thinking disturbance,anxiousdepressionand hostility/suspiciousness) decreased. housingand subsistenceimprovedbut substance abusedid not change. Onlypatientswho frequently took substances before treatmentconsumedlessor no substances at follow-up. During treatment, schizophrenics with polysubstance abusewere ableto learn better, and onsumeno or less substances than patientswithother dual diagnoses(e.g., personalitydisorders withalcoholdependency) but they could not stabilize and genera1ize their behavioural changein their everydaylives. The results are discussed concerning the impactfor. inpatienttreatmentfor patients suffering fromdual diagnosis.
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