The article discusses the concept of polyphonic consciousness of M.M. Bakhtin, developed by him on the basis of an analysis of the works of F.M. Dostoevsky. The principles of constructing dialogues in a literary work, based on the polyphonism of consciousness, are reflected in the theory and practice of analyticcathartic therapy. In particular, Bakhtin's concept makes a tangible contribution to the development of the problem of "internal dialogue", "dialogue with an imaginary Оther" and to the practice of the double duplication procedure.

The article presents an analysis of the multidisciplinary medical care to patients who have made a suicide attempt. A total of 109 patients with mental disorders complicated ин suicide attempts were examined. The average age of the surveyed was 37.8 ± 19.5 years (38 men, 42 women). The nature of suicide attempts, the severity of the general condition and the severity of the generalized mental state (according to the GAF scale), the structure of comorbidity of mental and somatic pathology were assessed. A wide range of mental pathology which complicated by suicidal attempts, was revealed, included the main diagnostic categories of ICD-10, regardless of the while mental disorder nature, exacted syndromes structure of the clinical picture was noted with a predominance of depressive (48.6 %) and anxiety-depressive (29,3 %) syndromes. The average value of the severity of the mental state on the GAF scale was 14.8 ± 4.7 points, while a very weak (r = 0.278) statistically significant (p < 0.05) correlation was found between the overall severity of the mental state and the severity of the somatic state due to perfect suicide attempt. The features of psychosomatic comorbidity, which determine the nature of suicidal behavior, the volume of psychiatric care and the tactics of managing patients of this category in a hospital setting, have been revealed.

The purpose of the study was to determine the relationship between the parameters of social apperception and self-regulation in patients with schizophrenia with different levels of social adaptation. The V.P. Serbsky National Medical Research Center of Psychiatry and Narcology (Moscow) examined 71 men with a diagnosis of "Schizophrenia", of whom 33 committed socially dangerous actions, that is, they had the highest level of social maladaptation. The comparison group included 20 men without mental disorders who were not brought to criminal responsibility. The assessment of the features of social apperception, self-regulation and their violations was carried out using a complex of psychometric and semi-selective methods. Violations of social apperception in schizophrenic patients with normative and criminal behavior are identified, and the relationship between social apperception and selfregulation in schizophrenic patients and healthy individuals is also investigated. In patients with schizophrenia who have committed socially dangerous acts, a greater number of relationships between violations of social apperception and self-regulation parameters were revealed. The components of social apperception that are significant for predicting the commission of socially dangerous actions by patients with schizophrenia are highlighted. It is shown that the greatest contribution to the attribution of schizophrenia patients to the group of persons with criminal behavior is made by excessive detailing of the situational context, introducing personal meaning into the interpretation of the situation with perceptual interference, producing aggressive alternatives with an information deficit.

This subject of the research is the features of the self-concept in people suffering from drug addiction. The aim of the work was to identify the characteristics of self-esteem among drug addicts. The data obtained were compared with the results of patients with alcohol dependence. The study sample consisted of patients from rehabilitation centers with a diagnosis (123 people with addiction to psychoactive substances ICD-10: F10-F19 and 135 with alcoholism). To analyze the results, methods of mathematical statistics were used: student t-test, descriptive statistics. The results of the study showed that people with drug addiction have low self-esteem and a tendency to self-sentencing. At the same time, people with drug addiction see value in maintaining family relationships and are considering implementing their plans in the future. In communication, they demonstrate ambivalent trends: isolation and indecision in communication, on the one hand, and the need for acceptance by the group on the other. The data obtained contribute to the development of theoretical knowledge in the field of psychology, psychotherapy and psychiatry, based on a deeper understanding of the addict. The study not only opens up the possibility of choosing more effective methods to support drug addicts, but also develops measures to prevent the formation of addictive behavior by correcting selfesteem and developing effective communication skills.

The article reveals the problems of the transition of higher medical educational institutions to distance learning in this difficult period of the coronavirus pandemic and the socio-psychological features of the learning process. The forced transition to a self-isolation mode during the coronavirus infection (COVID-19) pandemic gave a powerful impetus to the introduction of distance learning tools into the system of medical university education. The use of digital technologies at various stages of the training of future doctors has its own characteristics, since many skills and abilities at the modern level of technology development cannot be fully acquired otherwise than in practical classes in a traditional, full-time form. This primarily relates to the development of various manipulations, operations, research, the acquisition of experience in communicating with patients, conducting examinations, maintaining medical records, etc. At the same time, the forced transition to distance education was the only reasonable alternative to traditional education in the context of the COVID-19 pandemic. The positive features of distance learning are a decrease in the level of stress, the choice of the optimal pace of mastering the material, the availability of information resources, the formation of self-discipline.

The article presents the results of a study of the rehabilitation commitment of patients leading disabling pathologies. According to the results of the study, it was revealed that in groups of patients homogeneous in clinical, demographic and social indicators, but with different attitudes to disability, a different level of rehabilitation commitment is formed. In patients who repeatedly challenge the decisions of the medical and social expertise regarding the establishment of the status of "disabled" or the strengthening of the disability group, the rehabilitation commitment is statistically lower compared to patients who do not relate themselves to disability. The results of the study substantiate the need for psychological rehabilitation in order to correct maladaptive personality manifestations from the moment of the "debut" of the disease and throughout its entire course for the prevention of social maladaptation and the formation of rehabilitation commitment in patients.

On the basis of a comparative analysis, the influence of the length of service of employees of the Department of Internal Affairs (groups of employees with service experience up to 1 year, from 1 year to 5 years and over 5 years) on the dynamics of their stress resistance, strong-willed qualities and the coping strategies used by them is studied. Based on the results of the comparative analysis, it is concluded that the growth of stress resistance and the development of strong-willed qualities of police officers as their service experience increases with more frequent use of active adaptive coping strategies in their behavior. There are some signs of professional deformity in employees of the Department of Internal Affairs with more than 5 years of service experience compared to other employees, which is expressed in more frequent aggressive and impulsive behavior in stressful situations compared to employees with less service experience.

The article presents the results of a study of professional burnout in paramedics of emergency medical care (EMS). The survey involved 79 paramedics of the emergency medical service working in hospitals in the Arkhangelsk region, age 36.9 ± 10.5 years. The main research methods were questionnaires and psychological testing.

In 47.7 % of paramedics of the emergency medical service, a formed syndrome of professional burnout was revealed, manifested by fatigue, poor health, the appearance of physical and emotional exhaustion, as well as health problems. The development of professional burnout syndrome is associated with an increase in anxiety, a deterioration in relationships in the team, as well as an increase in the tension of non-constructive strategies for coping with stress (confrontation, distancing, escape-avoidance).

The article offers recommendations for the prevention of professional burnout syndrome in paramedics, which should be aimed at maintaining a favorable atmosphere in the team, teaching constructive psychological interaction and methods of self-regulation.

The article presents the experience of differentiation based on the results of a clinical and psychological study of cardiac surgery patients from three clinical groups of the psychotherapeutic target system. The targets are differentiated taking into account the needs of the cardiac surgery patients according to four levels - the level of psychological reactions of the individual to the situation of the operation, the level of its psychopathological manifestations, the level of dysfunctional characteristics of the personality and the level of specificity of social interaction, and are also correlated in detail with six stages of medical and psychological support. This made it possible to personalize the programs and individualize the routes of medical and psychological support for cardiac surgery patients.

The study of the structure of self - attitude of adolescents prone to Internet addiction was carried out. As a control group, adolescents who are prone to nicotine addiction and adolescents who are not prone to addictions were taken. The empirical data obtained indicate that the structure of self-attitude in adolescents prone to Internet addiction has a more negative character, in comparison with subjects prone to nicotine addiction and subjects without addictions. Such teenagers are characterized by greater dissatisfaction with themselves and their capabilities, low self-regulation, self-rejection, negative expectations from society.