Department of Extended Treatment and Palliative Care with Organic Involutional Disorders Unit

This department is dedicated to treating patients with resistant mental disorders, for whom previous treatments have not achieved stable remission, i.e., the withdrawal of disease symptoms and a return to a satisfactory level of functioning. There is a wide range of illnesses in which psychotic decompensation can occur that does not respond to available psychopharmacological and psychotherapeutic treatments, with a number of patients not achieving functional recovery. In addition to the most common functional psychotic disorders belonging to the group of endogenous psychoses such as schizophrenia, schizophreniform, and schizoaffective disorders, psychotic shifts can occur in deep depression, mania, delusional disorder, and may be triggered by physical illness or the use of psychoactive substances. It can also occur because of a profound personality disorder and intellectual disability. Psychotic shifts can occur in individuals with dementia, cognitive and mnemonic changes, and not only in elderly individuals but also in those who have experienced accidents, cerebrovascular trauma, or have a long history of addiction. Additionally, dementia can start manifesting in individuals in their thirties, still functional and employed, with a psychotic shift based on an organic, demonstrable substrate. We can admit adult individuals of both genders for treatment.

Many patients admitted to this department struggle to distinguish between their internal world and reality. They are emotionally distant, devoid of willpower and strength, burdened by the influence of visions and hallucinations, obsessions, stigma, and injustices that keep them from a fulfilled and happy life. The primary admission criterion of this department is that the patient suffers from a psychopathology that is resistant to the conventional use of medications to the extent that they cannot function in society and everyday life.

It is important to emphasize that a crucial component of the treatment involves conversation and educating family members. We strive to be available by phone or in person to provide all necessary information, while respecting the privacy and rights of the patients.

Treatment is based on a humane approach and the empathy of professional and experienced staff. Upon arrival, thorough laboratory analysis is conducted monitoring the patient's blood, biochemistry, liver function, kidney function, urine, and, when indicated, X-rays on state-of-the-art equipment, electroencephalograms, electrocardiograms, and ultrasound imaging. Treatment relies on the inevitable but rational and prudent use of medications in necessary doses, with particular attention to minimizing unwanted side effects. There is a tendency to use modern antipsychotics with a low side effect profile, sometimes in complementary combinations with classical ones based on decades of research and experience. The department also uses antidepressants, mood stabilizers, anxiolytics, and hypnotics. Whenever possible, each patient is involved in various forms of psychotherapeutic treatment, ranging from individual and supportive psychotherapy to group psychotherapy and therapeutic communities, as well as psychoeducation and cognitive-behavioral therapy, along with occupational activities. Patients are simultaneously cared for by a psychiatrist and nursing staff, receiving professional treatment from social educators, occupational therapists, physical therapists and speech therapists. Psychodiagnosis is conducted by clinical psychologists to clarify the organic, endogenous, or psychogenic components of the illness. Therapy is applied in collaboration with internists and neurologists to achieve the holistic well-being of the patient's body, personality, emotions, intellect and spirituality. Once tranquility is achieved, leading symptoms subside, aggression directed towards others or oneself is alleviated, and there is an understanding of one's own illness, self-criticism, and cooperation. Meeting these criteria, including continued medication adherence and follow-up appointments with the responsible psychiatrist, qualifies the patient for discharge. If possible, the patient is released to their family; otherwise, placement may be arranged in a foster family or a quality facility for mentally ill adults, ensuring round-the-clock care and attention to the proper administration of prescribed medications and regular check-ups.