The review of the Russian and foreign literature on the relationships of psychosomatic medicine and Balint supervision of physicians was conducted. We selected and analyzed articles from MEDLINE / PubMed Elibrary.ru, Scopus databases during from 1990 till 2020, international medical journals and collections of scientific papers as well as relevant references in the bibliography of the analyzed articles. The search was carried out with the usage of search queries of various combinations of the specified key words.

The “philosophy” of psychosomatic medicine and the theory of Balint supervision have the evident common historical grounds. Psychosomatic medicine and Balint supervision are united by the conception that the patient’s perceptions about his/her illness, related to it experiences and behavior as well as their relationships to his/her unconscious are very important in the therapy process. That means that the experiences and behavior of a physician related to the complicated communication with the patient are important as well. The patient has to be no more a passive object of the care so the process of therapy obtains the character of interpersonal communication and the mutual influence between the patient and the physician. This point is what Balint supervision is focused at. The technology of Balint group work helps physicians to shift an emphasis in the clinical practice from the disease-centered to the patient-centered approach. The analysis of Balint groups effectiveness provided during more than fifty years brought an evidence that Michael Balint presented very efficient method which helped physicians in different medical fields and psychologists reduce their emotional arousal in the treatment of “difficult” patients who are patients with psychosomatic disorders very frequently. The integrative relationships between basic approaches of psychosomatic medicine and Balint supervision in physicians and psychologists are described. The history of the relations and common principles related to the attention to the complexed issues of physician-patient communication and the therapy in psychosomatic disorders which becomes more successful due to the impact of analytical Balint supervision, are analyzed. The significance of Balint groups work in the training of the health care professionals, who are treating patients with psychosomatic disorders, difficulties and perspectives of implementation of Balint group method into the system of education and training of general practitioners, psychiatrists and psychotherapists are presented.

The article provides a review of the scientific literature devoted to postcoid conditions. The concept of postcovid syndrome, its structure, and epidemiology are disclosed. The article contains the results of 2 meetings of experts (psychiatrists, psychotherapists, neurologists) from different regions of Russia who had experience in providing care to persons with postkovid syndrome. Particular attention is paid to postcovid depression, its clinical characteristics, and the experience of therapy. It was noted that the severity of the post-coV syndrome did not depend on the severity of the infectious disease suffered. The leading variants of depressive syndromes observed in SARS-CoV-2 patients were: astheno-depressive, apato-depressive and anxious-depressive syndromes. Anhedonia, anxiety, cognitive disorders, insomnia, and hypochondria occupied a significant place in the structure of postcovid mental disorders. It is emphasized that persons with postcovid syndrome, as a rule, initially found themselves in the field of vision of internists, therefore, their training in the diagnosis of postcovid mental disorders is relevant. Clinical experience has demonstrated the feasibility of antidepressant therapy for postcovid depression and the high efficacy and safety, including the risk of drug interactions, of using vortioxetine, including prescribing the drug to the elderly and the somatically impaired. The article is illustrated with clinical examples.

The discourse is based on a review (article) by I.M.Zislin on an article by N.G. Neznanov et al. (Review of Psychiatry and Medical Psychology. 2019;1: 8-15). Based on the methodology and philosophy of science, the key words of the review are discussed. The subject of psychiatry as a medical (clinical) science is analyzed — the same for all its sections, taking into account the principle of demarcation. The humanitarian approach is reduced to the humanitarian (axiological, pragmatic) paradigm of psychiatry, in particular, the crisis of psychology. The importance of including spirituality in the biopsychosocial model (BPS model), mainly through psychotherapy, is pointed out.

At the basis of numerous mental disorders lies a synaptic transmission impairment that causes metabolic and ionic changes and affects the current functional state of the brain, the reflection of which we find in electroencephalographic examination.

Objective of the study: identification of electroencephalographic features in children under conditions of biochemical heterogeneity of hyperkinetic disorder (HD).

Material and methods. 404 children aged 6-8 years with HD were divided into three subgroups according to the state of monoamine activity: the 1-st subgroup with a combination of hypofunction of the dopaminergic and hyperfunction of the noradrenergic systems — 120 children, the 2-nd subgroup with a combination of hyperfunction of the noradrenergic system with relative balance dopamine — 136 children, and the 3-d with a combination of hyperfunction of the dopamine and hypofunction of the noradrenergic systems — 148 children. In the selected groups, the serotonin system plays an inhibitory and modulating role in relation to the catecholamine metabolism systems. The control group consisted of 90 children (54 boys and 36 girls). An electroencephalographic study was carried out, where the following ranges and subranges were differentiated: theta rhythm (4–8 Hz) and beta1 rhythm (14–20 Hz). The power ratios of theta — and — beta1 rhythms (theta/beta1) were calculated.

Results. It was the serotonin system that turned out to be the determining factor in the neurophysiological characteristics of HD. Moreover, the division into subgroups, based on the biochemical characteristics of children with HD, did not allow us to obtain significant differences. The only feature that globally distinguishes the subgroups from each other was the increase in the theta/beta1 activity index, corresponding to an increase in the tension and activity of the serotonin system from subgroup 1 to 3. The data obtained allow us to assert that the electroencephalographic index theta / beta1 can serve as a marker of inattention in children with hyperkinetic disorder and reflects the established state of imbalance of all monoamine systems, but better characterizes the behavior of the tryptophan system.

Conclusion. The data on the relationship between the power of theta/beta1 rhythms in the EEG may indicate the nature of the activity of the serotonin system in prospective studies, providing a personalized approach to the selection of drug therapy in children with HD.

Telepsychiatric assistance in the “doctor-patient” format is at the stage of formation and requires the solution of legal, organizational and methodological issues. The aim of the study was to substantiate the methodology of telemedicine consultations of patients (legal representatives) in child psychiatry. Material and methods. The analysis of the results of 1129 telemedicine consultations (TMK) in the «patient-doctor» format for 559 patients aged 2 to 18 years was carried out. Results. Remote consultations have been tested for the entire spectrum of mental disorders in childhood and adolescence. During the primary patient-doctor TMK, a number of serious regulatory and technical limitations were identified. Repeated TMK «patient — doctor» in child psychiatric practice are defined as the most optimal and safe. There was a significant increase in the number of repeated TMKs and the expansion of the specialties of consultants during the period of restrictive measures in connection with the COVID-19 pandemic. The assessment of the effectiveness of TMK was carried out by means of a sociological survey (questionnaire) of doctors and patients (legal representatives). Conclusion. A methodology has been developed for organizing and conducting telemedicine consultations for patients under the age of 18 (legal representatives) in the field of psychiatry. A survey of beneficiaries recorded their high readiness and satisfaction with remote counseling. A survey of medical workers revealed a positive trend in attitudes towards carrying out TMK. The negative dynamics of the opinions of specialists in connection with the increase in the level of workload indicates the need for further organizational, methodological and educational work on the use of telemedicine technologies.

The aim of the study — to establish the severity of cognitive, psychoemotional, motivational and behavioral disorders in patients after acute period of ischemic stroke.

Materials and methods. The study included 60 patients with a diagnosis of ischemic stroke. Depending on severity of neurological deficit according to the national stroke scale (NIHSS), patients were divided into two groups: group 1 — 30 patients with an NIHSS score of 0 to 8, associated with mild neurological deficit, group 2 — 30 patients with an NIHSS score of 9 to 15, associated with moderate neurological deficits. The study was conducted on the 7th day of treatment and included: assessment of the cognitive status according to the Montreal Cognitive Assessment scale; assessment of the level of distress, depression, anxiety and somatization using the Four Dimensional Symptom Questionnaire; assessment of mental and physical asthenia according to the MFI-20 scale, level of self-control using the Rotter’s Locus of Control Scale and assessment of the personality and the familial unconscious in Szondi’s test. Results. The study established the prevalence of depression and cognitive impairment in patients with moderate neurological deficits. Patients with mild neurological deficits are characterized by a moderate level of somatization, mental and physical asthenia, a low level of self-control in relation to health, low adherence to treatment and poor motivation to recover.

Conclusion. The results of the study indicate the need inclusion of assessment of psychoemotional factors and personal resources of the patient in relation to illness and recovery in early diagnosis of patients with stroke. Along with neurological deficits, it is necessary to assess the cognitive, emotional and motivational levels of the “internal picture of the disease”. This can help determine the patient’s basic compensatory and adaptive capabilities and develop individual rehabilitation strategies.

The aim of the present study was to examine the characteristics of early career psychiatrists’ (ECP) work in Russia and to assess the prevalence and severity of burnout in them. Material and methods. The Early Career Psychiatrists Council of the Russian Society of Psychiatrists conducted an anonymous online survey of ECP in Russia in July-August 2019, consisted of a structured survey and screening for professional burnout using the Maslach Burnout Inventory (MBI). The final sample consisted of 165 people. Results. A high level of burnout according to at least one of the MBI scales was revealed in 79 (78.2%) women and 39 (60.9%) men (p=0.017). Mean values of the MBI Emotional Exhaustion scale corresponded to 23.33±8.97 and 17.97±8.49 (p=0.003), the MBI Depersonalization scale — 10.46±4.81 and 9.16±4.22 (p=0.083), and the MBI Personal Accomplishment scale — 33.02±5.98 and 35.32±5.75 (p=0.026) for women and men, respectively. The following risk factors for professional burnout were identified: female sex, overlapping of several working positions, difficulties in work due to changes in documentation requirements introduced since the start of professional career. Protective factors of burnout development were: work in private clinic, satisfaction with work atmosphere, subjective estimation of quality of life as above average or as good as possible. Conclusion. Burnout was established in 71.5% of ECP in Russia, which corresponds to one of the highest burnout rates in psychiatrists according to international and national studies. Further research is needed to assess the prevalence and severity and ways to prevent burnout in psychiatrists in Russia.

Patients who face a stressful situation related to cancer and loss of a limb have not been thoroughly studied form a psychological perspective, what limits the possibilities of targeted psychological assistance and social rehabilitation. In this regard, the aim of the research was to study the clinical and psychological status, strategies and personal resources for coping with the stress of the disease, as well as the main parameters of the quality of life (QoL) of patients who underwent lower limb amputation due to cancer (group 1, n = 24, men — 62.5%, average age 47.25 ± 3.17), in comparison with patients amputated due to other somatic diseases not accompanied by an actual vital threat (group 2, n = 15, men — 93.3%, average age 59.67 ± 2.27), as well as with normative psychodiagnostic data. Methods of clinical and psychological diagnostics were used, including “Ways of Coping Questionnaire”, “Big V Questionnaire”, “Purpose in Life Test”, EORTC “Quality of Life of Cancer Patients Questionnaire” (QLQ-C30). It was found that functional capability (p<0.01), objective (p<0.001) and subjective (p<0.001) severity of pain syndrome, as well as employment (p=0.05) have the lowest indicators in group 1 compared with group 2; at the same time, the levels of QoL in both groups of patients do not differ and do not correspond the expert assessment, exceeding it; patients rate their cognitive and emotional activity most highly; the lowest, physical and role activity, and financial impact. In the structure of coping of group 1, the strategy “Seeking for social support” predominates; the values of the scales “Distancing” (p=0.05), “Escape–avoidance” (0.1<p<0.05), “Positive reappraisal” (p<0.05) are higher than in group 2, but lower than average normative values. In the personality of patients in group 1, “Conscientiousness” (p=0.01) and “Openness” (0.1<p<0.05) prevail in comparison with patients in group 2, as well as “Extraversion” (0.1<p<0.05), “Conscientiousness” (p<0.001) and “Emotional stability / Neuroticism” (p<0.05) — compared with the mean values of the test. The indicators of the scales “Meaning of life” (p<0.01), “Fullness of life” (p<0.01), “Life satisfaction” (p<0.01) in group 1 are higher than in group 2; patients’ internality is higher than in the control sample of men (0.1<p<0.05) and women (p<0.01). The results obtained can be used in the process of rehabilitation of orthopedic cancer patients.

Purpose: To describe clinical and laboratory features and define a role of alcohol as a barrier to adherence in patients with acute retroviral syndrome, to study readiness of infectious diseases specialists to discuss alcohol consumption issues with their patients. Research materials: Retrospective analysis of medical records of 112 patients with established diagnosis of acute HIV-infection was performed, 22 of them fulfilled an anonymous questionnaire regarding they readiness for starting antiretroviral treatment and alcohol consumption. 82 infectious diseases doctors answered anonymous questionnaire about their attitude towards patients with alcohol related problems. Results: Among 112 hospitalized patients with acute HIV-infection 2 had stage 2А, 96 — stage 2Б and 14 — stage 2В. All patients at stage 2B had oropharyngeal candidiasis. Mean inpatient stay were 10 days, 2 patients required ICU admission. Only in 10 patients (8,9%) antiretroviral therapy was initiated while in-hospital. Half of a patients who fulfilled anonymous questionnaire had a dangerous level of alcohol consumption. Only one third of patients fulfilled survey were ready to start antiretroviral therapy. Medical workers had a low score on motivation scale and satisfaction scale while asked about their attitude towards patients with hazardous level of alcohol comsumption. Conclusion: Patients with acute HIVinfection presented with variety of clinical syndromes and possessed a high potential for spreading disease across society. Underestimation of alcohol consumption along with lack of motivation to work with alcohol abusers are typical for doctors and might facilitate further spreading of epidemy.

Mental health and mental well-being of the population are the most important prerequisites for a good quality of life. A special position in the healthcare of the Russian Federation is occupied by the protection of the health of the younger generation, therefore, in the implementation of national projects, much attention is paid to the development of infrastructure for providing multiprofessional medical care to children and the prevention of mental and somatic diseases.

Purpose. Description of the model of saving the mental health of the adolescent population, implemented in the city of Kirov (model). The presented materials reflect the advantages and novelty of the model organized with the involvement of the resources of related departments for the implementation of psychological education and continuous prevention with a risk group in schools, routing of persons with prenosological have shown the effectiveness of diagnostics using psycho-diagnostic screening to identify RISK GROUPS and PHENOMENOLOGICAL MENTAL STATES for further preventive work and medical and psychological assistance aimed at preventing the development of clinically pronounced MENTAL DISORDERS with impaired social adaptation.

A detailed description of the stages of the model is presented, in which emphasis is placed on preventive work with the risk group in general education schools and medical, psychological and social care for persons with prenosological conditions in pediatric medical institutions, which reduces stigmatizing aspects and increases accessibility.

Step-by-step implementation of measures involving administrative and human resources of departments providing preventive care and medical and psychosocial assistance to adolescents allows you to model and adapt the structure without attracting additional economic costs, which shows the versatility and functionality of the model.