From the author: Scientific and practical journal “Forensic and social psychiatry” No. 2(13) May, 2011, pp. 91-94. Almaty. Integrated psychotherapeutic approaches in the treatment of schizophrenia in adolescents Sklyar S.V., Saduakasova K.Z. Republican Scientific and Practical Center for Psychiatry, Psychotherapy and Narcology, Ministry of Health of the Republic of Kazakhstan, Kazakh National Medical University named after S.D. Asfendiyarova Resume. The study focuses on the development, integration and implementation of psychotherapeutic treatments in combination with standard drug treatment for adolescent schizophrenia. Efficiency has been proven in repeated hospitalizations. Schizophrenia is one of the most common mental disorders, characterized by a combination of productive (hallucinatory-delusional, catatonic-hebephrenic, affective, etc.) and negative (apathy, abulia, alogia, emotional and social withdrawal, etc.) symptoms, behavioral and cognitive disorders ( memory, attention, thinking, etc.) and leading to unfavorable social and economic consequences (V.N. Krasnov, I.Ya. Gurovich, S.N. Mosolov, A.B. Shmukler, 2006). According to epidemiological studies, the prevalence of schizophrenia in the world is estimated at 0.8-1.0%. 45 million people suffer from schizophrenia. in the world, the number of new cases per year is 4.5 million people. Number of patients in 1985-2000 increased by 30%, corresponding to the growth of the world's population (WHO, 2001). According to the reports of the Republic of Kazakhstan for 2008-2009, there is a tendency towards an increase in the primary incidence of schizophrenia and schizotypal delusional disorders from 11.4 per 100 thousand adolescent population in 2003 to 12.2 per 100 thousand. adolescent population (“Psychiatric care to the population of the Republic of Kazakhstan for 2008-2009. Statistical collection”). The course and development of schizophrenia is influenced by various biological and psychosocial factors. According to Martens L., Addington J., (2001), intrafamily factors can have both a negative impact on the course of schizophrenia and the social adaptation of patients when relatives misperceive the disease and the patient, which contributes to the next relapse, and also have a sanitizing effect through the formation of social support , i.e. forms of assistance in overcoming (coping) in response to the demands placed on the individual by the environment, which has a positive effect on the patient’s adaptation. The role of pathologizing education in creating conditions for chronic frustration of a child and distortion of his personal and physical growth, leading in some cases to the formation of either neuropsychic or psychosomatic disorders, was drawn attention in the works of E.G. Eidemiller and V.V. Justickis (2005). Domestic authors G.M. Kudyarova pointed out the leading role in the treatment of mental disorders in children and the improvement of the traumatic microsocial environment through family psychotherapy. and Zaltsman G.I. (2000). One of the fundamental intrafamily factors is family upbringing, therefore, in the treatment of mental illnesses, in particular schizophrenia, the role of family psychotherapy is undeservedly given little. For many years of the existence of psychiatry, it was believed that psychotherapy could not have the proper therapeutic effect on patients with schizophrenia. Since the 50s of the last century, works have appeared exploring the role of the family in the origin of schizophrenia (D. Bell, D. Jackson, N. Ackerman, M. Bowen, 1950; D. Haley, V. Satir, G. Bateson, 1952). In the territory of the former Soviet Union, the idea of ​​the need for family psychotherapy in families of patients with schizophrenia began to be developed by E.G. Eidemiller (1989). There are theoretical and empirical studies of the influence of family factors on affective spectrum disorders (A.B. Kholmogorova, S.V. Volikova, E.V. Polkunova, 2005; A.B. Kholmogorova, 2006). The need for the use of family psychotherapy for schizophrenia is indicated by works of recent years (A.P. Kotsyubinsky, 2004; A.V. Golenishchenko, 2007; V.D. Vid,2008; A.V. Solonenko, 2009). These studies consider family psychotherapy within the framework of a psychodynamic approach, or emphasize psychosocial methods, without combining other family therapy approaches. The relevance of this problem is also justified by the fact that the role and significance of psychotherapy in adolescent patients with schizophrenia has not been studied in a psychiatric hospital. The purpose of the study: to create a model of integrated family psychotherapy in a psychiatric hospital for adolescents suffering from “acute” schizophrenia. Materials and research methods Diagnosis schizophrenia was established based on the criteria of the International Classification of Diseases, 10th revision (ICD-10) “Mental and behavioral disorders.” The study of the mental state of patients with schizophrenia included an assessment of initial manifestations and observation over time. We identified common and characteristic signs of each form of schizophrenia and built on this basis an analysis of intra-family relationships. The object of the study was patients of the department of child and adolescent psychiatry with a diagnosis of “acute” schizophrenia and their parents. The subject of the study was the role of integrated family psychotherapy, a psychoeducational approach in the complex with standard psychopharmacological treatment in a hospital setting. In accordance with the purpose and objectives, 178 people were examined. Of these, the main group consisted of 40 patients and 60 parents of these patients (40 families). The control group consisted of 78 patients. Research methods and instruments Clinical-psychopathological method (assessment of mental status and dynamics of the leading syndrome). Syndromes were defined according to the glossary of “Main syndromes and symptoms of mental illnesses of childhood” by V.V. Kovalev (1974); nosological assessment was carried out according to the multi-axial classification of mental disorders in childhood and adolescence, in accordance with ICD-10 (WHO, 1996). Follow-up method (frequency of hospitalizations, level of social functioning at the post-hospital stage were monitored). Pathopsychological and psychological methods (formalized psychometric methods) :- “Family sociogram” E.G. Eidemiller, O.V. Cheremisin (2002) modified by V.V. Pushina, I.M. Nikolskaya (2007). Using this projective technique, the representation of the “real” and “ideal” family by parents and adolescents was graphically revealed, which made it possible to evaluate and compare the concept of “family”, the level of self-esteem, relationships in the family, as well as readiness for change. - “Modified questionnaire for identifying types character accentuations in adolescents” (MPDO), developers S.I. Podmazin, E.I. Sibil (1996) modification of the “Pathocharacterological diagnostic questionnaire for adolescents” N.Ya. Ivanova, A.E. Lichko (1995). It was used to identify the personal characteristics of adolescents. - “Standardized multifactorial method of personality research” (SMIL), L.N. Sobczyk (2002), modification of MMPI by S. Hathway, J. McKinley (1940). It was used to identify personal characteristics (characterological, accentuations, psychopathy) of parents. - Questionnaire “Parents are assessed by children” (CHD) by I. A. Furmanova, A. A. Aladina, N.V. Furmanova, (1999), modification of the DIA questionnaire, V. Justitskis, E.G. Eidemiller (1990, 2000). Used to assess a teenager’s style of family education. - “Analysis of Family Relationships” (FA), developed by V. Justitskis and modified by E.G. Eidemiller (1990, 2000). Revealed the presence of pathologizing family education of the mother and father in relation to the teenager. - “Family Genogram” by M. Bowen. Psychotherapeutic method of influence. Clinical characteristics of patients and social data of the family. In the studied families of the main and control groups, sons predominated, respectively 23 (57.5%) and 49 (62.5%), which correlates with the data of various authors on the predominance of schizophrenia in adolescence in males. Age of first admission in the main and control groups.