[Statistical modeling of the fact and requests frequency for emergency medical care by primary care different age groups patients.]

The frequency of seeking emergency medical care (EC) can be mediated by the characteristics of the patient's social status, his health literacy (HL) but not only by the clinical signs of the disease, health status. The goal of the cross-sectional survey was to identify factors determining the frequency of applying for EC by the young-aged, middle-aged (18-59 years) and elderly (60-74 years) patients of the primary health organizations in the Arkhangelsk Region and the Komi Republic (North-West Russia). Logistic regression (LR) was used to identify factors mediating the fact of applying for EC; zero-inflated negative binomial regression (ZINB) - to identify factors mediating the frequency of appeals. The majority of elderly respondents in the Arkhangelsk Region (72,5%) and the Komi Republic (74,1%) applied for EC at least once during the calendar year; among the young-aged and middle-aged respondents - 45,3% and 52,1% respectively. In the group of young-aged and middle-aged respondents, a higher frequency of appeals for EC is mediated by the age, low self-esteem of the well-being and health status, a chronic disease(s) affecting daily well-being in anamnesis, a low level of HL; in the group of the elderly respondents - by the fact of absence of a spouse, low self-esteem of the well-being, a chronic disease(s) affecting daily well-being in anamnesis, low levels of HL respectively. The obtained results obtained can be used to identify the «risk group¼ of patients of the primary health organizations who have a higher probability of applying for EC, and to organize additional preventive work with the min primary health organizations.

[Relationship between mental and physical disorders in old age and senility.]

In order to identify the relationship between mental and physical disorders in the elderly and senile age, 70 patients were examined in one of the clinics in Arkhangelsk, including 56 (80%) persons aged 60-74 years and 14 (20%) people aged 75 years and older. A questionnaire was conducted, data from outpatient records were studied, and the clinical status assessment was used, as well as methods for determining mental and physical condition. The most frequent mental and physical disorders were the cognitive and depressive disorders presence, a high risk of malnutrition syndrome, sarcopenia and falls syndrome, reduced functional capabilities, while senile patients had significantly more pronounced disorders. It has been shown that the cognitive and depressive disorders presence in the elderly and senile increases the falling syndrome risk and reduced functional capabilities, and in old age - sarcopenia syndrome.

[Systematization of approaches to the organization of prevention of mental disorders veterans of combat veterans.]

For the purpose of methodological justification of the use of new approaches to the organization of psychiatric care for veterans of military operations in departmental general hospital health care institutions, the analysis of existing problems in providing psychiatric care to retired combatants with mental disorders of the system of the Ministry of internal Affairs (MIA) of Russia was carried out. It is shown that the existing organizational approaches have a number of significant drawbacks and do not fully provide quality therapy and medical and psychological rehabilitation to this contingent. Proposed in the development Concept of the psychiatric service of MIA to provide targeted prevention work with ex-combatants, current employees of power structures, including early diagnosis of early forms of mental disorders, timely provision of treatment & rehabilitation help with subsequent systematic monitoring of their mental health in government health facilities. This will not only improve the quality of diagnosis of mental disorders, but also improve the treatment of psychopathological disorders, reduce the stigma of psychiatric care and systematize the directions of work with this contingent at the stages of secondary prevention of changes in mental functions.

[Algorithm for stratification of women for differentiated therapy of menopausal syndrome in combination with perimenopausal melatonin deficiency syndrome.]

Climacteric syndrome (CS) is considered to be a frequent manifestation of pathological menopause. Menopause associated not only with deficiency of sex steroids, decrease of melatonin secretion is observed. Perimenopausal melatonin deficiency syndrome (SPDM) is the complex of symptoms, which is often formed amid decrease of melatonin synthesis and clinically characterized by the prevalence of complaints of sleep disorders (problems), bodily pain, depression, anxiety/fears and somatic symptoms. CS and SPD are co-morbidities, that impair the «women menopausal health¼. The article presents the stratification algorithm of peri- and post-menopausal women with the co-morbid pathology of CS and SPDM for selection of differentiated therapy. The algorithm involves detection of indications for monotherapy with melatonin or synthetic genistein, and for combined treatment with menopausal hormone therapy. The usage of this concept is reasonable for improvement of treatment efficiency of co-morbid pathology of CS and SPDM, for quality of life improvement and for induction of active ageing of women of senior group.

[Perimenopausal melatonin deficiency syndrome in system of personalized management of quality of life of women with climacteric syndrome.]

The aim of our study is to search diagnostic tools for early detection of prenosological melatonin deficiency in postmenopausal women and women in menopausal transition with climacteric syndrome for establishment effective personalized prevention and treatment programs. In this study 221 women were enrolled. They were divided into four groups: the 1st group - 39 women in menopausal transition with climacteric syndrome, the 2nd group - 104 menopausal women with climacteric syndrome, the 3rd group - 41 women with physiological menopause, the 4th group - 37 healthy women in reproductive-age. The study was conducted using the test for detecting melatonin deficiency, women's health questionnaire (WHQ), and morning level detection of 6-sulfatoxymelatonin in urine. A new prenosological state - perimenopausal melatonin deficiency syndrome was build on the data obtained. It is appropriate to evaluate prognosis of melatonin treatment in women with climacteric syndrome during the planning of personalized prevention and treatment programs. The assessment of prognosis is carried out with the help of the discriminant mathematical model, which is the basis of personalized management of quality of life in women with climacteric syndrome. This system is based on participatory principles.

[Areas for the provision of mental health care to retirees of the Russian Ministry of Internal Affairs.]

With the aim to study trends in the provision of psychiatric care to pensioners, the Ministry of internal Affairs (MIA) of Russia in the framework of the implementation of the concept of departmental mental health services conducted a solid analysis of the state of mental health 111 pensioners of MIA, who seek medical assistance in the Center of Mental Health (CMH) across the Kirov region in the period from February to November 2018. All respondents were divided into two groups: the 1st - 56 persons with mental disorders (average age of 59,3+1,3 years), the 2nd - 55 people with before painful mental health disorders (average age from 59,9+1,1 years). Clinical examination and analysis of medical records were carried out. It is shown that the mental health of pensioners of MIA, who applied for help in CMH is characterized by polymorphism of psychopathological symptoms from severe mental disorders (schizophrenia, organic personality disorders) to short-term symptomatic psychopathological disorders and before painful neurotic conditions. It is proposed to provide comprehensive assistance to veterans of MIA with mental disorders within the framework of the concept of development of the psychiatric service of MIA and to involve in the diagnosis and therapy, along with psychiatrists, regular medical psychologists. This will not only improve the quality of diagnosis of mental disorders, but also improve the therapy of psychopathological disorders, reduce the stigmatization of mental health care and systematize areas of work with this contingent at the stages of secondary prevention of changes in mental functions.

[Organization of psychiatric assistance to pensioners of the Ministry of internal affairs of Russia.]

For the purpose of systematization of the directions of rendering psychiatric help to pensioners of law-enforcement bodies (OVD) of the Russian Federation with mental disorders, the analysis of the existing normative legal acts regulating psychiatric examination of employees of Department of internal Affairs of the Russian Federation at dismissal on retirement and attachment on medical care in departmental healthcare institutions is carried out. It is shown that the provision of specialized psychiatric and psychotherapeutic assistance to pensioners of internal Affairs of the Russian Federation is carried out mainly in the municipal health care system, there is no monitoring of the mental state of pensioners of internal Affairs of the Russian Federation, including combatants with post-stress disorders. Within the framework of the project Of the concept of development of the psychiatric service of the Ministry of internal Affairs of Russia, it is proposed to systematize approaches to the organization of psychiatric care for pensioners of the Ministry of internal Affairs of the Russian Federation with mental disorders in the structure of departmental health care, with the improvement of the regulatory legal framework for the organization of psychiatric care, which will ensure the provision of high-quality psychiatric care.

[The Dynamics of Morbidity of Mental and Behavioral Disorders Caused by Alcohol Consumption in Population of the European North of Russia in 2006-2015].

The development of organization of narcological care to individuals abusing alcohol production and patients with alcoholism presupposes organization of monitoring and detailed analysis of incidence and prevalence of the given group of states. The purpose of study is to establish tendencies in dynamics of morbidity of mental and behavioral disorders caused by alcohol consumption in population of pre-arctic regions of the European part of Russia in 2006-2015. The study used data from annual forms # 11 "Information on morbidity of narcological disorders" of the Murmansk, Arkhangelsk oblasts and the Republic of Komi in 2006-2015. On the basis of this data the indices, including standardized ones, were calculated concerning primary and total population morbidity of mental and behavioral disorders caused by alcohol consumption. Since 2006, in pre-arctic regions a significant decreasing of incidence and prevalence of alcoholic psychoses (F10.4-7), alcoholism (F10.2, 3, 8, 9), alcohol consumption with unhealthy aftermaths (F10.1) was established. The discrepancy in ratio of rate of alcoholic psychoses prevalence (F10.4-7) and chronic alcoholism (F10.2, 3, 8, 9) in Murmansk, Arkhangelsk oblasts and the Republic of Komi is established that testifies a possible misrepresentation of statistical data. The established tendencies in dynamics of incidence and prevalence of mental and behavioral disorders caused by alcohol consumption indicate on ambiguous results of public anti-alcoholic policy in the European North of Russia and indirectly testify redistribution of patients between public and private narcological organizations.

[Cognitive and affective disorders in the elderly].

To develop algorithm of diagnostics of cognitive and affective disorders in elderly and senile age 98 representatives of this age group were examined (1st group - 68 persons 60-74 years, 2nd group - 30 patients older than 75 years). For the diagnosis of cognitive disorders the developed and adapted «Short rating scale of cognitive functions¼, to diagnose emotional disorders - «Ðospital scale of anxiety and depression HADS¼ were used. Cognitive impairment was revealed in 39,8% of the elderly (1st group - 28,7% in 2nd group - 61,6%). Affective disorders 51,6% of respondents had; however, signs of anxiety - 40,9% and depression - 27,7%. Algorithm for the diagnosis of cognitive and emotional disorders in elderly and senile age, comprising the steps of: screening and diagnostic, clinical and pathopsychological, laboratory and instrumental diagnostic, psychodiagnostic, can be recommended for use in general medical practice (therapists, general practitioners, geriatrics) for an earlier secondary prevention and, if necessary, early correction of mental health disorders.

[The dynamics of formation of psychic disordersof combatants and pensioners of the ministry of internal affairs.]

Retrospective analysis of the dynamics of formation and nosological structure of mental disorders among the pensioners of the Ministry of internal Affairs (MIA) with the retirement on superannuation of mental disorder impeding further passage of service. All respondents were divided into two groups according to the criterion of participation in hostilities. It is shown that the ex-combatants, pensioners of MIA in the clinic dominated by organic disorder associated with the consequences of closed traumatic brain injury mine blast etiology, despite the rendered medical aid, the formation of personality disorders that violate social functioning and lead to disability. Pensioners of MIA, who was not involved in pain action, revealed the presence of severe neurotic with a decline in socialization and the formation of chemical dependency and the subsequent development of organic disorders of the Central nervous system predominantly alcoholic etiology, resulting in poor social functioning and to disability. The data obtained indicate certain weaknesses in the organization of psychiatric care to this population: the limited psycho-prophylactic and correctional activities, late diagnosis of borderline mental disorders. To reduce the risk of the formation of personality disorders and chemical dependency have retired police officers it is necessary to improve the organizational and methodological approaches to carrying out annual medical examination of personnel of the interior MIA.

[Demographic and social predictors of place of death in the group of elderly].

Analysis of data from the 2814 Medical certificates of death was performed to reveal socio-demographic characteristics of citizens who died at elderly age, depending on the place of death and alcohol anamnesis. Divorced or single elderly people with lower educational status had greater odds ratio to die «on the street¼ or «at home¼ rather than in a «medical organization¼ (respectively to characteristics of demographic status and the structure of causes of death). Clinically verified diagnosis of «Mental and behavioral disorders due to alcohol¼ (F10) in anamnesis was not associated with the «choice¼ of place of death among elderly people. Obtained results can be used to develop the regional programs in the field of public health.

[DIAGNOSIS OF EMOTIONAL SPHERE DISORDERS IN ELDERLY].

The article describes the structure of criteria of severity and recommendations for the diagnosis of emotional sphere disorders in elderly. An algorithm for diagnosis of emotional sphere is described, which includes four phases: screening and diagnostic, clinical and patho-psychological, laboratory and instrumental diagnostic, psycho-diagnostic; it can be applied as to estimate the prevalence of various forms of emotional disorders, and for their early correction and prevention at the individual level. The criteria of anxiety expression evaluation and asthenic disorders are presented. The recommendations can be used in the activities of somatic practices doctors (therapist, general practitioners, neurologists).

[DIAGNOSIS COGNITION IN ELDERLY].

This article provides recommendations for the diagnosis of cognitive in the elderly. An algorithm for the diagnosis of cognitive impairment, including four stages (clinical psychopathological, express psycho-diagnostic, clinical psycho-diagnostic, instrumental), which can be used to identify elderly patients with preclinical forms of cognitive impairment and implementation of primary and secondary prevention efforts is presented; determination of the degree of cognitive impairment (mild, moderate, severe) in the elderly can recommend the future directions of medical and rehabilitation care. Recommendations can be used to provide guidance to general practitioners.

[Alcohol anamnesis and a death place factor: Role in mortality rates due to leading cardiovascular diseases].

AIM: To reveal the specific features of marital status and educational level in people who have died of leading circulatory diseases (CDs) in Arkhangelsk in relation to the place of death, alcohol anamnesis, and demographic characteristics (gender, life span). Materials and methods. Data on the diagnosed underlying cause of death, marital status, educational level, and place of death were copied from 4137 medical death certificates (form 106/y-08) of all those who had died in Arkhangelsk in 1 July to 30 June 2012. Data on patients registered at a psychoneurology dispensary as having a diagnosis of alcohol-induced mental and behavioral disorders (F10) were copied. The data were statistically processed using the procedures of binary and multinomial logistic regression analysis. RESULTS: A total of 2101 people (50.8% of the total number of deaths) died of CDs (ICD-10 Class IX) in the study period. Male sex and a compromised alcohol anamnesis were associated with untimely death (less than 60 years of age) from acute conditions in ICD-10 Class IX. Male sex, a compromised alcohol anamnesis, and negative characteristics of marital and educational statuses were related to untimely death from chronic conditions in ICD-10 Class IX. Single people having a lower educational level and a compromised alcohol anamnesis statistically more frequently died of CDs outside a health care facility. CONCLUSION: The results of the investigation suggest that there is inequality in the excess risk of death from leading CDs among the representatives of different social population groups in Arkhangelsk, as well as nonequivalence in their interaction with the public health system.

[Preventive psychiatry directions of early childhood]. / Napravleniya profilakticheskoi psikhiatrii rannego detskogo vozrasta.

Due to the increase in the frequency of mental pathology in the child population the issues of preventing mental disorders and protecting the mental health of early age children are becoming particularly relevant. To substantiate a new interdisciplinary direction of scientific and practical research-preventive psychiatry of early childhood and to identify priority areas for its development. The problems that arise when working with young children are analyzed. Algorithms for identifying deviations in mental development in young children and the gradual participation of psychiatrists in the interdepartmental provision of early care to children with the proposed author's diagnostic methods and methodological approaches are presented. The author substantiates the need to identify a new direction - early childhood psychiatry and identifies its main interdisciplinary areas, including: analysis of risk factors and prediction of developmental deviations, identification of children at risk; medical examinations, identification and diagnosis of developmental disorders in young children, the introduction of innovative diagnostic methods; dynamic monitoring of identified children at risk and assistance by an interdisciplinary team of specialists; support for families raising children at risk; training of specialists.

[The influence of premorbid personality traits on the formation of borderline mental and psychosomatic disorders in retired combatants]. / Vliyanie premorbidnykh lichnostnykh osobennostei na formirovanie pogranichnykh psikhicheskikh i psikhosomaticheskikh rasstroistv u pensionerov-kombatantov.

OBJECTIVE: To identify the influence of premorbid personality traits on the borderline mental (BMD) and psychosomatic disorders formation in combatant pensioners of the Ministry of Internal Affairs (MIA) of Russia. MATERIAL AND METHODS: The study included 186 male MIA pensioners in the Kirov region aged 34-64 years (mean 46.5±5.8 years). The participants were divided into two groups depending on their participation in combat operations: 106 retired combatants of the main group (MG) and 80 people who were not participants in combat operations during their service (the comparison group (CG)). We used a clinical/psychological method with the study of medical documentation, including acts of the military medical commission, protocols of the Center for psychophysiological diagnostics and outpatient patient records, experimental psychological method with the use of a standardized multi-factor method of personality research in L.Sobchik's adaptation. RESULTS: The stressful conditions of official activity associated with participation in local armed conflicts combined with premorbid neurotic overcontrol of behavior, rigid attitudes, pessimism and social introversion contribute to BMD and psychosomatic disorders formation in retired MIA combatants. MG combatants had a 5.2 - fold higher chance of developing a mental disorder according to the Cochran Q-test (95% CI: 2.7-10) than retired CG who did not participate in combat operations. There was an average correlation between the compared features (V=0.377). CONCLUSION: The results indicate the need to improve the approach to the professional psychological selection of candidates for service, taking into account the initial personality characteristics and functional characteristics of the proposed position. It is required to develop personality-oriented programs and psychocorrectional measures when sending employees of the Russian Interior Ministry units on business trips to emergency zones with subsequent targeted rehabilitation of all combatants.

[General and primary incidence of mental disorders and their structure in people referred for support to the medical facilities of internal affairs organizations]. / Obshchaya i pervichnaya zabolevaemost' psikhicheskimi rasstroistvami lits, nablyudayushchikhsya v meditsinskikh uchrezhdeniyakh organov vnutrennikh del.

OBJECTIVE: To analyze the structure of the incidence of mental disorders of persons attached to medical support to the medical units of the Ministry of Internal Affairs of Russia (MCH MIA) for the period 2013-2018. MATERIAL AND METHODS: Statistical reports of medical organizations of the Ministry of Internal Affairs on people who applied for psychiatric care in 2013-2018 are analyzed. The data were compared with the same indicators for the Russian Federation. RESULTS: Mental disorders in people referred to the medical facilities of the Ministry of Internal Affairs are represented by seven clinical groups: F00-F09 - organic, including symptomatic mental disorders, F10-F19 - mental disorders and behavior disorders, associated with the use of psychoactive substances, F20-F29 - schizophrenia, schizotypal and delusional disorders, F30-F39 - mood disorders (affective disorders), F40-F48 - neurotic, related to stress and somatoform disorders, F50-F59 - behavioral syndromes associated with physiological disorders and physical factors, F60-F69 - personality and behavior disorders in adulthood. On average these indicators were 8,5 times lower than those in the Russian Federation, while the incidence of primary mental disorders of this contingent was only 2 times lower than the primary morbidity of the Russian Federation. CONCLUSION: The majority of mental disorders are neurotic, stress-related and somatoform disorders, which, with timely diagnosis and comprehensive treatment, can be fully treated.

[The role of saturated fatty acids in impaired lipid metabolism in patients with alcohol dependence syndrome]. / Rol' nasyshchennykh zhirnykh kislot v narushenii lipidnogo obmena u patsientov s sindromom zavisimosti ot alkogolya.

OBJECTIVE: To determine the content and role of saturated fatty acids (SFA) in lipid metabolism disorder in patients with alcohol dependence syndrome (ADS). MATERIAL AND METHODS: A total of 123 men were examined: 44 patients with ADS and 79 healthy people. The patients were examined on the 5-6 day after admission to the hospital. The content of saturated fatty acids (SFA) (caproic, caprylic, capric, undecyl, lauric, tridecane, myristic, pentadecanoic, palmitic, margarine, stearic, arachin, eicosanoic, behenic) was determined by gas-liquid chromatography. Quantitative calculation of SFA levels was carried out by the AgilentChemStationB.03.01 program (USA). The ratio of stearic to palmitic acid (C18:0/C16:0) was calculated. The study of the enzymatic activity of aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma glutamyltransferase (GGT) was carried out by generally accepted standardized methods on a Cobas Mirra automated analyzer. RESULTS: In ADS patients, changes in the composition of SFA were found with an increase in the number of short-chain fatty acids (caproic acid by 52.2%, caprylic acid by 75.5%); medium-chain acids (capric acid by 47.9%, undecyl acid by 74.7%, lauric acid), but with a decrease in the concentration of long-chain acids (pentadecanoic by 5.1%, margarine by 34.7%, arachinic by 19.58%, eicosanoic by 26.6%, behenic by 5.1%). Less correlations between the fatty acid content and the parameters of the lipid transport system of blood serum were established in ADS patients compared to the controls. This indicates deep disorders of lipid metabolism. CONCLUSION: The results expand the understanding of the complex mechanisms of lipid metabolism disorders in ASD, which is important for secondary prevention. They also substantiate the need for a purposeful study of lipid metabolism disorders in patients with ADS at an earlier stage of the disease.

[The structure of mortality of patients under dispensary supervision diagnosed with alcohol-related mental and behavioral disorders].

AIM: To identify the characteristics of mortality in patients under dispensary supervision with mental and behavioral disorders caused by alcohol (F10) in Arkhangelsk city. MATERIAL AND METHODS: Information obtained from certificates of death made out for people died in 2011-2012 who were registered in a regional psychoneurological dispensary was used. RESULTS: Mental and behavioral disorders caused by alcohol were diagnosed in 6,5% of patients, mean life longevity was 51,6 years while in others it was 67,8 years. Percentage of patients died from diseases of blood circulation system (40,6%) and tumors (13,8%) was relatively low while percentage of patients died from injuries, poisoning and other environmental factors was higher (28,6%). CONCLUSION: Alcohol abuse is a significant risk factor for population health of Arkhangelsk city. The structure of mortality of patients under dispensary supervision is characterized by the considerable prevalence of conditions that are potentially avertible. Differences in the approaches of forensic medicine experts and autopsists to the assessment of causes of death in these cases can lead to misrepresentation of statistical data on mortality structure.