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Introduction. Modern concepts of education are based on the principles of anticipation, determination of the present by the future (advanced education, Life Long Learning). The same pattern applies to the personality of both the subject of life in general and professional life in particular. Aim. Based on the theoretical and methodological analysis, identification and empirical research of the psychological characteristics of the future, the present research aims to consider the future as a personal construct in the structure of the subjective image of professional life. Methodology and research methods. The key methodological approaches are the subjective approach and the theoretical and methodological foundations for using the synergetic approach to study the psyche, mental phenomena and processes. The study employs survey methods; the methods of mathematical and statistical data processing: comparative analysis and factor analysis were carried out using the IBM SPSS Statistics v.20 program. Results. Based on theoretical ideas about time modes, time perspective, psychological characteristics of organisation and perception of time, as well as the results of an analysis of the works of foreign and Russian authors, a structural-functional model of the subjective image of professional life is proposed, including four blocks: a block of retrospection, a block of regulation of actual activity, a prognostic block, and a transspective block. Scientific novelty. The use of a subjective and synergetic approach to modelling the image of the professional future is justified. A structural-functional model of the image of the professional future is proposed, including invariants that represent a formal and meaningful representation of the temporal modes of the past, present and future and a mechanism for comparing the current state with the desired (“needed future”). Practical significance. The presented structural-functional model of the subjective image of professional life can serve as the basis for the development of a subject-oriented approach to professional guidance and support of professional development at the stage of choosing a profession and professional training with practical means of constructing a professional future.

Aim. To assess the effect of depressive disorder (DD) on the clinical presentation of coronary artery disease (CAD) and five-year survival rate of patients with chronic CAD.Materials and methods. The study included 79 patients with functional class II–III exertional angina who experienced myocardial infarction more than 6 months before. The patients were divided into two groups: group 1 (n = 45) consisted of patients with CAD and depression and group 2 (n = 34) encompassed patients with CAD without depression. The clinical presentation of CAD was assessed by the results of filling out the angina pectoris self-control diary and exertion tests. The presence and severity of DD were determined using psychometric scales, such as Hospital Anxiety and Depression Scale (HADS) and Beck Depression Inventory (BDI), and verified by the psychiatrist. Information about five-year survival was obtained via telephone interviews with the patients and their relatives.Results. Patients with CAD and DD were characterized by more frequent episodes of angina pectoris during a week (10 [8; 14] vs 6 [4; 7], p = 0.000004), an increased demand for nitroglycerin (4 [0; 10] tablets vs 0 [0; 4] tablets, p = 0.001), and lower exercise tolerance (50 [25; 75] W vs 75 [50; 75] W (p = 0.06), 350 [250; 400] meters vs 435 [350; 500] meters (p = 0.01) than CAD patients without DD. The five-year survival rate was significantly lower in group 1 than in group 2 (69 [62; 72] vs 71 [68; 72] months (p = 0.04)), 35 (77.8%) vs 32 (94.1%) patients survived. In group 1, a greater number of deaths from cardiovascular accidents (10 (22.2%) vs 2 (5.9%)) was noted (log-rank test, p = 0.03).Conclusion. In patients with CAD, associated depression results in aggravation of the clinical course of CAD and poor disease prognosis, which requires timely diagnosis and treatment of DD.

This review presents epidemiological data on the effect of sex hormones and reproductive status on the level of blood pressure (BP) and the incidence of es­sential hypertension (EHT) in women. The role of estrogen deprivation and hyper­androgenism in the development of EHT in peri- and postmenopause is discussed. The main mechanisms of EHT in periand postmenopausal women: sympathetic and renin-angiotensin-aldosterone system hyperactivity, salt-sensitivity, high prevalence of abdominal obesity, metabolic syndrome, left ventricular hypertrophy, left atrial dilatation and high risk of atrial fibrillation, stroke and heart failure with preserved left ventricle ejection fraction. Data on the efficacy and tolerability of the main classes of antihypertensive drugs in women is presented. We discussed the mechanisms of selective I1-imidazoline receptor agonists and the results of cohort studies of moxonidine monotherapy and its combination with other antihypertensive drugs and hormonal menopausal therapy in peri- and post­menopausal women. Moxonidine reduces high blood pressure in peri- and postmenopausal women and has a beneficial effect on metabolic syndrome components, but is also effective in patients with hypertensive crises, especially with sympathetic hyperactivity.

Aim. To determine the differences in self-assessment of social functioning by patients with chronic coronary artery disease (CAD), depending on the presence of comorbid affective disorders (ADs).Materials and methods. Using the Social Adaptation Self-Evaluation Scale (SASS), which makes it possible to assess the degree of social functioning and satisfaction with various aspects of social life, we studied the features of the social functioning of heart hospital patients with chronic CAD with (n = 248) and without AD (n = 291). In 290 patients (average age 56.6 ± 6.7 years) with chronic CAD, chronic ADs (45%) were revealed; depressive episodes (DEs) were diagnosed for the first time in 24% of patients, and 24.5% of patients had recurrent DEs. Bipolar disorder was found in 6.5% of cases. Qualitative and quantitative parameters were investigated using the Mann – Whitney U test and Student’s t-test. To assess the frequencies, the Pearson’s chi-squared test was used.Results. The mean total SASS score in the patients with chronic CAD with AD corresponded to difficult social adaptation (33.7 [29.5; 39]), while the patients without AD had good social adaptation score of 40.8 ± 6.3 (p < 0.05). In the group without AD, patients with normal social adaptation prevailed (n = 215; 73.8%), while patients with AD more often had difficulties with social adaptation (n = 148; 59.7%). In the CAD patients, depending on the presence of AD, the frequency of disturbances in various spheres of social adaptation differed: employment, interest in and pleasure from activities, disposition of income, pleasure from and interest in seeking information, social support (p = 0.001).Conclusion. Higher frequency of pronounced impairment in social functioning in patients with chronic CAD with AD determines the need for taking this fact into consideration when planning rehabilitation measures in this group of patients.

Aim. To identify the presence and the correction method of decreased heart rate variability (HRV) in patients with chronic coronary artery disease (CAD) and comorbid depressive disorders (DD).Materials and methods. 79 patients with CAD (with class II–III angina pectoris and myocardial infarction that occurred more than 6 months ago) were divided into two groups. The first group included 50 CAD patients with depression, and the second – 29 CAD patients without depression. 17 patients received agomelatine (1st subgroup), 12 patients received fluvoxamine and fluoxetine (2nd subgroup), and 21 patients refused to take antidepressants (3rd subgroup). Initially and after 6 months, the HRV parameters were evaluated using the SCHILLER MT-200 Holter-ECG apparatus (Switzerland).Results. A significant decrease in HRV was revealed in the patients with depression compared to the patients without it: SDNN (96 [83; 117] ms vs. 110 [98; 127] ms; p = 0.02), SDANN (80.5 [67; 94] ms vs. 91 [79; 102] ms; p = 0.03), SDNNindex (46.5 [38; 56] ms vs. 55 [48; 66] ms; p = 0.006), rMSSD (29 [23; 38] ms vs. 33 [29; 45] ms; p = 0.04), pNN50% (3.9 [2.4; 5,7] vs. 5.7 [2.9; 12.6]; p = 0.03). Initially, the 1st, 2nd, and 3rd subgroups did not differ in all HRV parameters. Against the background of antidepressant therapy, there were significant differences between the 2nd and 3rd subgroups in SDNN (110 [96; 140] ms vs. 85.5 [75; 103] ms; p = 0.008), SDANN (93.7 ± 22.9 ms vs. 72.7 ± 21.4 ms; p = 0.02), SDNNindex (55.8 ± 16.4 ms vs. 42.4 ± 10.8 ms; p = 0.01) and pNN50% (7.8 ± 6.7 vs. 3.6 ± 1.8; p = 0.02), as well as between the 1st and 3rd subgroups (SDANN (93.6 ± 28.5 ms vs. 72.7 ± 21.4 ms; p = 0.03), rMSSD (36.5 [28.5; 51] ms vs. 26.5 [25; 32] ms; p = 0.02)).Conclusion. In patients with CAD with comorbid DD, significant impairment of heart rhythm regulation occurs due to a pronounced decrease in HRV, which can seriously affect the course and prognosis of CAD. Prescribing modern antidepressants can be used as a method of correcting autonomic dysfunction in patients with CAD with comorbid depression.

Aim. To determine gender differences in self-reported social functioning of patients with comorbidity of affective disorders (ADs) and chronic coronary artery disease.Materials and methods. Self-reported social functioning of 248 cardiological patients (194 men (78.2%) and 54 women (21.8%)) with chronic coronary artery disease (CAD) and ADs was studied using the Social Adaptation Self-evaluation Scale (SASS). The mean age of patients with chronic CAD in men was (57.2 ± 6.5) years, and in women (59.3 ± 7.1), p = 0.04. Qualitative and quantitative indicators were investigated using the Mann – Whitney, Wilcoxon and T-test; χ2 (Pearson›s goodness-of-fit test) was used to estimate the frequencies.Results. ADs were represented by chronic mood disorders (45%), first-time depressive episodes (DEs) 24%, recurrent DEs 24.5%, as well as bipolar II disorder (BD II) 6.5%. ADs in 42.4% of patients were associated with psychosocial stressors (mainly, loss), p = 0.02. Men statistically significantly more often (37.1%, 72/194) than women (16.7%, 9/54) communicated more scarcely with others as a result of projection mechanisms, a high level of hostility, passive aggressiveness and lack of initiative, typical for patients with ADs, p = 0.003.Conclusion. The social functioning of patients with ADs and chronic coronary artery disease was complicated irrespective of gender. Women were single and bereaved of their children more often than men. Due to the low level of communication outside the family and outside of professional activity, most of the patients maintained communication mainly with the family. However, due to ADs, they were not able to feel support from familymembers and rarely initiated communication with other people (men did it statistically significantly more often than women).

The aim of the study was to reveal clinical and dynamic characteristics of affective disorders (AD) in comorbidity with alcohol addiction (AA).Materials and methods. 65 patients with affective disorders [22 women (34%) and 43 men (66%)] were examined. The main group included 34 patients aged 44.5 [36.0; 51.5] with affective disorders and comorbid alcohol addiction The comparison group included 31 patients aged 45 years [32; 52] with affective disorders without comorbid narcological pathology. Compared groups were matched by sex, age and nosological structure (p > 0.05). The following methods were used in the study: clinical and psychopathological, clinical follow-up, psychometric, statistical, as well as these psychometric scales: Clinical Global Impression (CGI), Hamilton Depression Rating Scale (HDRS-17), Hamilton Anxiety Rating Scale (HARS), Social Adaptation Self-evaluation Scale (SASS).Results. The comparative assessment of clinical and dynamic characteristics of affective disorders and social adaptation level was conducted. Chronology of occurrence of comorbid affective disorders and alcohol addiction was analyzed.Conclusion. Addition of alcohol addiction to affective disorders worsens the clinical and dynamic indices and social adaptation level of patients.

Review discusses the problem of non-vitamin K antagonist oral anticoagulants safety in patients with non-valvular atrial fibrillation. Bleeding risk assessment while applying anticoagulant therapy, preventive methods for major bleeding (intracranial, gastro-intestinal) during this therapy as well as the strategy of treating patients with bleedings occurring on direct oral anticoagulants intake are discussed in this review. Special attention is paid to the choice of direct oral anticoagulant, the importance of specific antagonist of dabigatran – idarucizumab and indications for its clinical application.

Objective: to study cognitive functions and level of proteins of acute brain damage in a group of patients receiving Cerebrolysin, and in a comparison group in the pre- and postoperative period of coronary artery bypass graft surgery.Materials and methods. The open-label randomized comparative controlled parallel study included 60 men. The average age in the group of patients receiving the therapy with Cerebrolysin was 61.5 (57÷66) years, and was – 61 (56÷65) years (р > 0.05) in the comparison group.Results. Groups differed statistically significantly according to the left ventricular ejection fraction: 56 (48÷64) – in the group of comparison, 61 (59÷65) – in the group of patients receiving therapy with Cerebrolysin (p < 0.05). In the group of patients receiving Cerebrolysin, an increase in score according to MMSE (р < 0.01) was noted from 25 (24÷27) to 26.2 (24–28) points, and in the group without brain neuroprotection in the preoperative period a decrease in score according the Mini-Mental State Examination was revealed to be from 25.5 (25÷27) to 25 (23÷27) (р < 0.01). Clinical value of the level of protein S100ß as a biological indicator of postoperative cognitive dysfunction after cardiac surgery was ambiguous and required additional research.Conclusion. Brain neuroprotection with use of Cerebrolysin (authors’ schema) promoted not only maintenance but also improvement of cognitive functions and decreased the likelihood of complications in mental activity after coronary artery bypass graft surgery under conditions of artificial circulation and cold cardioplegia, particularly in patients with a high risk for their development.

Objective: to identify the structure and clinical features of affective disorders (AD) and efficiency of antidepressants in in-patients with chronic coronary artery disease (ChCAD), living in Tomsk and the Tomsk Region.Materials and мethods. At a heart center, 1,131 patients with ChCAD were examined: in 290 persons (25.6%) AD were revealed, among them 72.1% were men (n = 209) and 27.9% were women (n = 81). Mean age of women was (63.5 ± 9.4) years and in men (57.9 ± 7.2) years (р = 0.004). AD structure, main syndromes, severity of depression and anxiety according to data of self-questionnaires and clinical scales before and after antidepressant therapy (predominantly with selective serotonin reuptake inhibitors (SSRI)) were studied. Comparative analysis of clinical indices of CAD respective from AD, presence of antidepressant therapy and its efficiency was performed.Results. Chronic AD were found in 45% of patients. Newly diagnosed depressive episodes made up 24.5% and recurrent depressive disorder (RDD) was 24%. 6.5% were bipolar affective disorders (BAD), predominantly bipolar II disorders. Depressive syndrome in 91.7% of patients had the second significant component (more frequently 54.8%). Characteristic of the clinical picture was dominance of complaints of bodily discomfort and pain, anergy and anhedonia. Moderate mental disturbances made up 49.0% (CGI). AD manifested at the age of 48 (40–55) years and preceded development of ChCAD. Natural course of AD was observed in 52.4% of cases. 47.6% (138/290) of patients received antidepressants, and only in 42% (58/138) clinically significant improvement was noted (more than 50% according to CGI). It was difficult to encourage patient adherence to long-term therapy (30–50% according to CGI). Physical activity tolerance (PAT) according to data of veloergometry increased in responders. Psychopharmaco- and psychotherapy should be included into rehabilitative programs for patients with ChCAD and AD.

The article presents a theoretical analysis of the problem of formation of professional identity in conditions of uncertainty and increasing multidimensionality of professional and educational space. The attention is focused on the fact that the dynamics of social processes is expressed in changing the requirements for the content and quality of work, the complexity of professional training. The multifactorial nature of professional development leads to the complication of the strategy of building a professional trans-perspective and requires a specially organized acmeological support of the identification process at the stage of vocational education. Within the theoretical review the definition of professional identity with the description of its structure is given, the author’s definition of professional trans-perspective is proposed. An important part of the article is the results of an empirical study of the features of professional identity and professional trans-perspective of students who are future teachers of vocational training. The interrelation of the main characteristics of professional trans-perspective - length, event density with indicators of professional identity: maturity, formation, activity of professional position, educational and professional plans - is revealed. Thus, the characteristics of professional identity can be considered as predictors for predicting a person’s professional future. In the final part, it is proposed to intensify the work on the development of professional identity of second-year students by supplementing the curriculum with elective modules aimed at the deficit aspects of professional self-determination.

The issue of improving the quality of education by developing individual educational trajectories is considered. The relevance of this topic is determined by the necessity to predict the development of personality in a changing vocational and educational space. The definitions of “individual educational trajectory” concept in the context of the continuing education system and educational environment of university are given. Attention is given to the need to conform the goals, objectives, content, forms and methods of continuing education to the need of conscious self-realization of personality in the projecting and implementation of his/her own trajectory in dynamic, asymmetric, open, undefined terms of socio-professional life. It is argued that the forms of sense generating and skills of designing and forecasting his/herself in professional future may be envisioned through accompanying, navigation activity corresponding to the needs and content of the stages of professional formation. The stages of professional development, event forms of continuing education and the basic psychological neoplasms arising in the process of professionalization are correlated. The conditions and predictors of construction of individual educational trajectories are analysed. It is concluded that vocational education should be human-like systems, which effectiveness criterion should be not actual economic feasibility, but the ability to form the personality and willingness to self-realization in a complex, dynamic world of the professions.

The research is aimed at investigating the possibility of reformingof professional-pedagogical education on the base of process and project approaches. The urgency of this problem is caused by the changing of requirements for the modern professionals and the lack of evidence-based strategies of teacher training for vocational education system.Methods. Methodological bases of development strategy of vocational teacher education involves process approach, that provides the continuity of the educational system management and is aimed at improving the quality of vocational training; and project approach oriented to the changes in the existing traditional education.Results and scientific novelty. The authors have identified the basic trends of modernization of professional pedagogical education in the conditions of transition to the sixth technological order. Strategic benchmark is the conversion of vocational teacher education in the humanities and technological education. The condition for such transformation is the integration of process and project approaches in the management of educational systems. The authors allocated the identification characteristics of process and project approaches in the system of innovative education. Modernization of the vocational education system requires the solution of problems including the following: methodological training of teachers and the development of their readiness to innovate; definition of priority directions of science and education and innovation activities of the educational institutions; optimization the educational programs and strengthening their professional and pedagogical orientation on the basis of problem-modular design of educational content; search technology of the formation and development of socially and professionally important qualities and the competencies of teachers; scientific-pedagogical maintenance of psychological and pedagogical training and professional development of teachers. The requirements for the organization to developmental professional and educational environment and the educational process are proposed. The authors defined the topics of the targeted educational projects aimed at improving the quality of psychological and pedagogical training and improvement of the humanitarian and technological qualification of teachers of vocational school. Practical significance concludes in the possibility of applying the data analysis in the design of innovative educational activities in the system of vocational teacher education.

Цель: оценить в сравнительном аспекте частоту развития тревожно-депрессивных расстройств (ТДР) у пациентов ИБС с постинфарктным кардиосклерозом (ПИКС), перенесших реваскуляризацию миокарда. Материал и методы: обследовано 139 пациентов мужского пола с ПИКС, поступивших в отделение реабилитации больных НИИ кардиологии СО РАМН, страдающих ИБС. Пациенты были разделены на три группы: 1-ю группу составили больные, которым проводилась ЧТКА со стентированием (n=36), 2-ю - пациенты, перенесшие операцию АКШ (n=30), больным 3-й группы (n=73) инвазивное лечение ИБС не проводилось. При поступлении, помимо общеклинического обследования, всем больным проводилось скрининговое тестирование госпитальной шкалой самооценки тревоги и депрессии (HADS) и шкалой тревоги Шихана. При выявлении повышенного уровня тревоги и депрессии (более 8 баллов по HADS и более 30 баллов по шкале Шихана), пациентам проводилось консультация психиатра для уточнения диагноза и определения способа коррекции ТДР. Результаты: в группе консервативного лечения ИБС выявлено значительно больше больных без психических расстройств, чем в группе АКШ: 60% и 36,7% соответственно (р=0,03). Частота тревожных расстройств в 1-й группе составила 8,3%, во 2-й - 17%, а в 3-й - 5%, причем у пациентов, перенесших операцию АКШ, они выявлялись чаще, чем в группе без вмешательства (р=0,049). У больных, которым проводилось инвазивное лечение ИБС, расстройства депрессивного спектра встречались достоверно чаще, чем в группе консервативного лечения: в 1-й группе 31%, во 2-й - 33,3%, в 3-й - 15% (р=0,05 и р=0,04 соответственно). Уровень тревоги по шкале HADS между группами не отличался и составил 7,3±3,7 баллов 1-й группе, 7,3±4,0 баллов во 2-й группе и 6,3±3,8 баллов в 3-й группе (р>0,05). Однако, по результатам тестирования шкалой Шихана обнаружено, что у больных, которым проводилась операция АКШ в анамнезе, уровень тревоги был выше в сравнении с пациентами без хирургического вмешательства: 32,3±19,9 баллов во 2-й группе и 22,5±15,2 баллов во 3-й группе (р=0,05). По шкале HADS уровень депрессии также оказался выше у больных 2-й группы, чем 3-й: 7,4±3,1 баллов vs 6,1±3,5 баллов (р=0,05). Наблюдение за пациентами продолжается. Заключение: ИБС чаще сочетается с тревожно-депрессивными расстройствами у пациентов, перенесших операцию АКШ, чем у больных с консервативной тактикой лечения (63,3% vs 40%). Однако не только больные после операции АКШ нуждаются в психологической реабилитации, но и пациенты, которым было проведено эндоваскулярное лечение коронарной болезни сердца. Таким образом, группе больных ИБС после реваскуляризации миокарда необходимо проводить более тщательное психодиагностическое тестирование с целью выявления и определения способа коррекции обнаруженных расстройств.

Психическое состояние пациента влияет на исход оперативного вмешательства. Цели. Информирование о сути вмешательства, разделение ответственности за результат (мотивация и подкрепление сотрудничества), увеличение степени доверия врачу, формирование настроя на позитивный исход вмешательства. Условия. Беседу лучше осуществлять в отдельном кабинете. Более эффективно, если подготовку начинает лечащий врач, затем кардиохирург и анестезиолог. Следует заметить, что осмотры этих докторов проводятся не только для определения тактики вмешательства, но и для получения доверия пациента. Примерный алгоритм беседы. Узнать имя-отчество пациента. В течение беседы как можно чаще обращаться к больному по имени-отчеству. Представиться (назвать ФИО; должность, звание, опыт работы). Молодому специалисту уместно отметить, что он «пристально интересуется подобными состояниями» и «имеет курс специальной подготовки и допуск». В доступной форме рассказать пациенту о сути болезни и необходимости вмешательства. Предупредить о «возможных неприятных ощущениях, с которыми нужно справиться». В данном случае стоит рассказать об успешном опыте преодоления этих проблем другими больными («Один пациент вашего возраста (сейчас он вернулся к работе) рассказал, что ему было легче, когда он...»). Можно попросить больного подумать, как легче это преодолеть, и позже поделиться своими ощущениями и опытом, «поскольку это очень важно» для вас. Указать риски и выгоды вмешательства. (Отметить для пациента, что риск для жизни в условиях современного оборудованного стационара составляет не более 3%, тогда как больные часто оценивают риск в 50%). Описать другие способы контроля над симптомами. Информировать о риске невмешательства (в том числе на протяжении времени). Предупредить об особенностях послеоперационного периода, примерном времени восстановления. Указать пациенту на степень его ответственности (ожидаемое от него поведение, действия). Поинтересоваться тем, есть ли вопросы или сомнения у пациента по беседе. Желательное поведение врача для выработки высокой степени доверия: поддерживать контакт глазами, подбадривающе покачивать головой, прикасаться к кисти руки пациента. «Замечать» пациента в коридоре улыбкой, кивком головы или коротким вопросом о самочувствии. Поощрять его поступки, направленные на управление самочувствием, любые позитивные изменения поведения. Некоторые фразы, помогающие справиться с пессимистическим настроем пациента. «Стопроцентные гарантии может дать только Бог. Вы можете попросить его и верить в его поддержку». «У нас очень квалифицированные специалисты, современное оборудование. Пациенты находятся под круглосуточным наблюдением». Фармакологическая поддержка. Препаратами выбора при тревожных состояниях, связанных с оперативными вмешательствами являются анксиолитики. Таким образом, может осуществляться психологическая подготовка пациента к оперативному вмешательству на сердце в условиях работы междисциплинарной команды как этапа биопсихосоциальной реабилитации.