Roundtable discussion with early-career scientists

O.K. Hello, dear viewers. The new issue of the Consortium Psychiatricum came out in September, and we continue the tradition we started this year of talking to our editors and authors. After each issue of the journal, which is published quarterly, together we discuss the relevant topics raised in it. This issue is quite special. We invited young scientists to participate in its creation. The guest editors were Sergei Potanin, Head of the Young Scientists Council, Russian Society of Psychiatrists, and Egor Chumakov, also a member of the Council, and the Head of the research coordination group at the European Psychiatric Association (EPA ECPC). In addition, we held a scientific papers competition for early-career scientists. Some of the submitted manuscripts, which received high marks from the jury members, were published in the new issue. Today the authors of the articles are here with us, and I would like to ask them to introduce themselves.

M.S. My name is Mikhail Sorokin, I am a Scientific Secretary at the Bekhterev National Medical Research Center for Psychiatry and Neurology, and recently I became the Chairman of the Young Scientists Council of the Bekhterev Society of Psychiatrists; it is a regional branch of the Russian Society of Psychiatrists in St. Petersburg. I have the honor of being a co-author of two articles published in the September issue of your journal.

O.K. If I am not mistaken, you are even the last author of two articles, meaning you had a leadership role.

M.S. The last author of one of the articles, yes, but in the second, just a co-author. 

E.K. My name is Evgeny Kasyanov, I am a practicing psychiatrist, researcher at the Department of Translational Psychiatry of the National Center named after V.M. Bekhterev. I am also a member of the Executive Committee of Young Scientists of the Russian Society of Psychiatrists, the creator of the popular science website Psychiatry & Neuroscience. I also have the honor of being one of the co-authors of an article published in the Consortium Psychiatricum journal. 

О.К. Very well. Let’s talk about the following. Very soon, on October 10, we will celebrate our main holiday among psychiatrists, the Mental Health Day. This year's main theme is «Make mental health & well-being for all a global priority «with a special focus on mental health at work. Let's first talk about mental health in general, and then we'll talk a little about your research, scientific interests, and your papers that were published in the journal. Both of you are active members of the Young Scientists Council. Could you tell us what prompted you to do this? After all, you can just be a doctor in a clinic, for example, or in a hospital, or you can fulfill your potential in the field in a different way. What motivates you to be more than just a doctor?

M.S. OK. First of all, I can speak about myself, my experience. At some point, I quite consciously realized that I wanted to do scientific research in the field of psychiatry, psychology, and neurosciences. This was probably due to a certain crisis in my professional development. There was a very difficult clinical situation with one of my patients, and I realized that devoting myself only to clinical work is risky. This is when you have only one point of support, and if for some reason it suddenly turns out to be shaky, then you no longer have enough confidence in the future, not enough understanding: why am I doing this? Will I continue to do this? For me personally, research is, in the broadest sense, prevention of both professional deformation and emotional burnout, and an important factor in psychological balance. Because when there are several sources of fulfillment in life, when there is an opportunity to receive valuable feedback in several areas at once, it really provides both emotional and psychological support. So, my answer turned out to be very personal. This is my personal psychological support. 

If we talk about the field, then I sincerely believe that a modern psychiatrist, and a modern doctor in general, who stays outside of the context of medical science is someone who greatly deprives themselves. Medicine is developing very fast, there is a huge amount of information, and if a modern doctor does not have the tools to understand this avalanche of biomedical information, it is difficult for them to find their way and reasonably use the most advanced methods. This is why I believe that it should be an important element in the basic training of a psychiatrist: some general principles of biomedical research. In the future, this will allow, even without having a direct connection with research in practical work, to navigate through the latest data.

O.K. It turns out that a crisis in the workplace, the matter to which the UN is now paying so much attention right now, served as a point of growth and expansion of professional horizons.

M.S. In my case, it was exactly like that. 

О.К. Egor Chumakov, one of the guest editors of the special issue, has just joined us.

E.K. I agree with Mikhail, because I also believe that the scientific/clinical dichotomy is to some extent artificial. It would be very difficult for a good scientist to make any breakthrough in the diagnosis and treatment of mental disorders without clinical thinking. On the other hand, I know a lot of fellow doctors who work only as doctors, but at the same time read PubMed, look through new articles, new clinical guidelines, sort of understand the types of scientific studies, and if they have a clinical question, they address particular databases. The division here, probably, is only in whether the specialist has knowledge in scientific methods. This is what distinguishes a scientist from a non-scientist. This also includes knowledge of basic medical statistics. 

My story is similar to the story of Mikhail: a few years ago, a thought came to me which frightened me very much and led to the main insight that I want to share. I provided very intensive consultations almost every day, and I realized at some point that they distract me from my scientific work, that I do not have time to cope with my current tasks, because I have to do consulting. However, having caught this passive thought, I tried to work it out and came to the following conclusion: whatever we do in science, it should be about diagnosis and treatment of mental disorders. It should, one way or another, maybe indirectly, lead to its improvement. Every single patient can enrich our knowledge about the course of the disorder, certain peculiarities. In the future, we can stratify the sample, introduce this variable into our study map. Therefore, for me personally, this discovery served as a cushion, a buffer that saves me from professional burnout.

O.K. If we talk about the dichotomy of science and practice, very often practitioners argue that statistics means generalization, it’s all about samples, and every patient is individual, and therefore we will rely on our personal experience and professional instinct, and statistics is statistics.

E.K. Indeed, it is a common argument, but a similar antithesis can be heard from scientists who do not want to delve into this discussion. They may say: Your personal experience is at the very bottom of the pyramid of evidence, you should rely on the general trends that we find in systematic reviews, meta-analyses, umbrella reviews, and so on. These are the two camps that create this artificial dichotomy. I believe medical work with patients and knowledge of some evidence-based treatment and diagnostic strategies are complementary, not mutually exclusive.

M.S. I would like to add something. I also feel like the above mentioned opposition is a bit artificial in this case. Doctors use the concept of professional experience. But professional experience is also observation of a large number of patients. Statistics allow you to multiply the number of these observations. A doctor will never be able to examine ten thousand patients in half an hour, while full-scale studies allow you to conduct an analysis not by yourself, but with the help of colleagues who have already investigated some kind of research topic. And these data are not opposed to the personal, clinical experience of the doctor, but ideally should complement it. Becoming a psychiatrist is not just about reading books. We always start by examining the patients, talking to them, watching how our more experienced colleagues conduct clinical interviews. It is the combination of what we have seen, what we have read, and what other researchers have done in large population studies using statistical methods, that defines clinical thinking. It is never formed solely on the basis of "I think so." It is the sum of all knowledge, therefore, in my opinion, it is somewhat artificial to single out some part from the whole spectrum of possibilities to better understand mental health. For example, if we say “I’m not gonna read meta-analyses because I think statistics are lies,” then we impoverish our clinical experience.

O.K. If I summarize your answers, it looks like what started as some kind of personal need for development, has resulted in improving professional medical skills. It also benefits patients: by processing a lot of scientific information and having the skill to understand it, you can ultimately help them in the best possible way.

M.S. For me it is absolutely true, yes.

O.K. In this context, I would like to mention a study whose authors include E.M. Chumakov and M.Yu. Sorokin. You conducted a survey named “Professional Values and Educational Needs of Mental Health Professionals” and submitted the study to the competition. Could you tell us a bit more about it?

E.Ch. This study did not come from a scientific interest, but from a practical one. We wanted to reorganize the work of the St. Petersburg branch of the Young Scientists Council of the Russian Society of Psychiatrists so that it could better meet the needs of our target audience, young mental health professionals. To that end, we compiled a short survey. There were more questions initially; we meticulously removed them, cleaned them up and left only the essential. The link to the survey was distributed among the participants of the School of Young Psychiatrists in St. Petersburg and then through psychiatric organizations in St. Petersburg, including the Bekhterev Center, where a large number of staff and students took part in this study.

O.K. What are your main findings? What have you discovered?

E.Ch. I believe this study is generally quite novel to the psychiatric community in Russia. We rarely talk about what matters to us as employees and not as people who provide medical care. Not about mental disorders, treatment, diagnostics, but about our feelings, our quality of life as specialists, which also, of course, affects the quality of the psychiatric care we provide.. Why do we do this? What is important to us? These are aspects related specifically to the quality of work. I hope there will be more such research. When I was at the American Psychiatric Association convention in 2019, I was struck by how many sessions and symposiums were devoted specifically to working conditions, the difficulties they faced while working: organizational, domestic, even environmental; there was also the eco-agenda. And I thought that this is great, this is right, we need to deal not only with treatment, but also with improving the quality of work. As for the results of the study, I think that one of the key results was that the interest in intellectual activity and the interest in scientific and educational activities among the respondents turned out to be very high. Of course, we cannot yet talk about some kind of representative population sample, it was only a pilot study, but it showed, in my opinion, quite interesting results. People who are directly involved in clinical work are focused not only on the clinical aspect, but on other related areas. Including the development of so-called science-oriented skills: working with scientific literature, scientific publications, studies.

O.K. Yes, I also found it very interesting. In your study, you called it "intellectual stimulation." It turned out that your respondents indicated it as the main professional value. On the one hand, this is unexpected, and on the other hand, very encouraging. If we are talking about burnout, especially among doctors, especially among psychiatrists (we are leaders in burnout, mainly young people), then it seems to me that it can be a kind of self-treatment, prevention of this burnout which specialists are inherently prone to. I just noticed  that you recruited respondents among those who, by default, already had something to do with science. Or am I wrong? Was there a larger sample?

E.Ch. Yes, there was in fact a large sample of people. The bias may be that these were people who attended the School of Young Scientists. That is, they already had an interest in some kind of education. But that was just the beginning, the study also involved psychiatric organizations, so a fairly large sample was collected.

O.K. And how are you planning to introduce the results of this study into the work of the Council of Young Scientists? After all, that was your ultimate goal, wasn't it?

E.Ch. Yes, we are planning to start new initiatives. Last year we started a journal club focused on scientific skills on the one hand and on communication skills on the other, since to participate you are supposed to not only to read articles, but also to tell something about them. We even had one meeting, which was held jointly with the European Federation of Psychiatric Trainees, for which we chose an article in English, Mikhail also participated. It was a very rewarding and interesting experience, I really liked how it was all done. We also have plans for further development. I do not want to reveal all my cards just yet, because we need to think over the organization first.

O.K. I can only express my wish that early-career scientists from Moscow are also involved in this activity, otherwise it’s like you have a whole intellectual center with advanced technologies there in St. Petersburg, while we are mainly talking about just the clinical aspect here. By the way, we have also launched scientific and journal clubs at our Mental-health Clinic No. 1 named after N.A. Alexeev, but a more expanded, all-Russian format would be even better.

M.S. I couldn’t agree more. I believe that such studies and the wonderful competition held by your journal, which we had the opportunity to participate in, play an important role in creating a professional community. This is incredibly important in terms of obtaining additional resources, emotional and professional, and support in difficult clinical, personal and professional situations, as well as prevention of emotional burnout. It is no coincidence that many groups were originally designed to provide help within the community.

I strongly believe that the purposeful development of the professional community is a tool that allows both saving the resources of specialists and, more importantly, improving the quality of medical care within the specialty. So, we are always open to similar initiatives.

O.K. Your study has also shown that young professionals want to improve their English, when it comes to educational activities. I can confirm this. For our part, we launched an additional elective in English as part of the residency, which also involves scientific activities, because they read articles in English, which kills two birds with one stone: improves the grasp of the language and the knowledge of science. In addition, your St. Petersburg Council of Young Scientists proposed an interesting initiative: to hold symposiums of young scientists in English at conferences. We have scheduled such an event for October 31 at the conference on "Mental Health of the person and society". Taking this opportunity, I would like to once again announce this symposium and your wonderful idea. From what I have seen, it is organized very well. And it feels as if you are at an international conference.

M.S. Right, on the one hand, this was a response to the natural restrictions that we have been facing since the beginning of the pandemic. Travel and contacts in the language of international communication have become very limited, and the online format of speeches is still somewhat different. Within the anniversary congress of our center held in May, we quite consciously tried to create such a precedent for the Council of Young Scientists symposium in English. As Egor rightly noted, we are trying to implement the results of the study in our daily work: we saw a certain interest among young professionals in improving their English skills, and we’re trying to provide them with another opportunity to present the results of their research in English. We are very glad that you are supporting this idea and we will take part in the October conference with great pleasure.

O.K. Since we are talking about the COVID-19 pandemic, on the one hand, it seems to me that this was a tragic page in the history of mankind, and on the other hand, for scientists, it was not only inspiration for new studies, but also a rare, unique opportunity to finish everything that was not finished during the lockdown period. Another study that earned a special prize of sympathy from the Chair of the jury and was referred to by other members of the jury as “intriguing”, is the study in which Evgeny Kasyanov and Mikhail Sorokin are co-authors: "Association of Anxiety and Depression with Objective and Subjective Cognitive Decline in Outpatient Healthcare Consumers with COVID-19: А Cross-Sectional Study". Could you tell us a little about the study, what motivated you to investigate this topic, what were the main findings, why did you decide to submit this paper to our competition?

E.Ch. Perhaps every self-respecting scientist in Russia and the world has addressed the issue of Covid-19. I even saw this idea on Twitter: to subtract Covid articles citations from the h-index and the impact factor, to make such an amendment, since so much data has been published, and so many articles are just citing each other. Obviously, it makes it  very difficult to find information that is really relevant to mental health. For our article, I was involved in the development of the protocol, the training of raters, and residents who conducted the study. We had the idea to focus, among other things, on the cognitive complaints of the patients, to see what the predisposing factors are. In my opinion the main findings are that objectively validated cognitive decline does not correlate with complaints of depression and anxiety, while subjective complaints that are not supported by cognitive tests correlate very well with a person's emotional state. It turns out that if a person has complaints related to some cognitive functions (problems with concentration, forgetfulness) then in addition to assessing their cognitive status, mood and anxiety level should also be assessed. And if you ask me, this is the main practical conclusion of our study.

O.K. So, if a person complains of cognitive decline, then in fact it can be not only a cognitive decline, but also that their emotional state is disturbed. And if there are no complaints, they might still have it, you still need to check.

E.Ch. That’s right. Screening is everything. It is easier to prevent than to treat. 

O.K. The average age of your participants also seemed interesting to me. You have recruited a very large group, more than 500 people, among the patients of outpatient clinics. And the average age was 41. We are talking about cognitive decline, which you assessed using MoCA, a screening scale for dementia and other cognitive impairments that are traditionally associated with old age. How can you comment on the fact that young people, forty-year-olds (at this age you can still be a member of the Young Scientists Council) suffer from cognitive decline?

E.K. I can try to explain. We developed the methodology with our first author, Natalya Gomzyakova. The fact is that MoCA certainly has validation based on data from patients with confirmed Alzheimer's disease with dementia, but at the same time, MoCA is a tool that is used not only for screening for dementia. The cutoff was made for patients with dementia, but the tool itself, MoCA, is used, among other things, to screen for cognitive deficits in patients with mood disorders, with schizophrenia. On the official website of MoCA you can find many articles on various disorders, including neurological ones, e.g. chronic pain syndrome. MoCA is used everywhere, because, unlike MSE (Mental State Examination), it has a wider scope of application. MSE is more suitable for moderate to severe dementia. MoCA can be used simply to assess cognitive decline not related to dementia. 

O.K. And what about those poor forty-year-olds who have been found to have cognitive impairments? 

M.S. I would like to elaborate on that. This study is in part exploratory, and we honestly wrote about it in the methodology section. By the time this study was planned, and it was planned very quickly, during the second wave of the pandemic, there really was already a huge number of publications on psychological stress, anxiety due to the pandemic, and so far, there were only preliminary data that the coronavirus disease specifically affected cognitive function. And it was not very clear how exactly. So we were guided by that information, which at that time was still only in preprints. We were interested in whether there really were specific profiles of cognitive impairment, and what they might be related to. Some of our data confirmed this information: indeed, depending on the severity of the course of the infectious process, the cognitive functions of our patients were impaired. This indicates the artificial nature of the division between medicine as a whole and psychiatry, which, as if the latter wasn’t related to our body, as if our brain was not inside the body, but floating somewhere nearby, and mental functions are not generated by some physiological processes, but by something else. As was known before, infectious diseases, and COVID just emphasized it once again, are associated with multisystem disorders: mental functions are also affected. And our study shows how. Even patients without risk factors for dementia, due to their relatively young age, nevertheless experienced certain cognitive impairments. They were minimal, not at the level of moderate or severe dementia, MSE would not show anything here, but it was a more precise tool assessing a wider range of cognitive processes that allowed us to identify these patterns. I think this, in its own way, once again highlights how unnatural it is to divide medics into internists and so-called psychiatrists who, as it were, have nothing to do with human beings and their organs, but deal only with some lofty matters. It's not like that at all. We have the same substrate as all other physicians.

O.K. I don’t know if you have any plans for this, but it would also be interesting to conduct a follow-up examination of these people, to see what happens to their cognitive functions over time. Of course, I understand that it is difficult to organize.

M.S. It is a difficult question due to the fact that COVID has put us in a situation where both research and daily work had to be practically restructured, reformulated from the ground up, and in some other parts of our research we have prospective data, but in the case of cognitive impairment, these were patients who again applied to the general internal medicine network, and it was rather difficult to trace them. 

O.K. Thank you very much. I think that despite the fact that COVID seems to be receding, research will continue. There are many plans on how to introduce early-career doctors to science, and how to make their professional development exciting. You yourself are very active and enthusiastic people. 

Our conversation is coming to an end, and I have the traditional question for you. Our journal is, in my opinion, quite an unconventional project for Russia. The approach to the editorial process that we have is not quite standard. I’m curious to know what you think. You have many publications in both Russian and international journals. Maybe you could give some feedback about your experience with us?

E.Ch. My experience overall was very positive. I really appreciated the work of the editor, which, among other things, helped to find some mistakes in English. Despite the fact that a native English speaker participated in writing. It was interesting. In general, everything is very professional. It's great that there are special people who deal with organizational issues. Not the way it is often done, when the researchers, after returning home from work, continue doing something, respond to emails; it is always very difficult. Your journal certainly looks much better in this regard. 

E.K. Let me continue. I can probably say, as an outsider, how I see the development of this journal. There are several breakthrough moments for me personally. The first one is happening right now. Interviews with the authors of articles, co-authors, editors, it's really cool. I believe, JAMA psychiatry, this whole line, is doing something similar, but only in the form of podcasts.

It is always very interesting to listen to, because the authors see their results more deeply, they can notice some things that are difficult for ordinary readers to see. I have been in contact with CP through press releases that are published on various popular science platforms. It is crucial for the information field, not only in psychiatry, in medicine, but for the society as a whole. If we do not publicly discuss the issues that we have regarding our patients, mental disorders, we do not draw attention to this, which leads to such things as lack of funding, there is a direct connection. Therefore, the fact that CP makes press releases is very important. 

What do I, as an author, as a person who chooses journals, expect in general from Russian journals? Maybe someday I will write a post about it. First of all, I wish you an early entry into SCOPUS, into WoS, because this is very important, it will significantly increase your competitiveness. And, of course, to make online publications possible,  before the release of the main issue, because sometimes if scientists have a grant, a number of articles, they really don’t want to wait for a long time. As far as I understand, this has not yet been introduced in Russian psychiatric journals.

O.K. We do have online-first, we have already put it into practice. 

E.K. Online-first? Really? This is amazing! Then there is only the first wish. Because if this happens, the answer to the question of the number one journal in Russian psychiatry is clear.

O.K. Thank you. We have already submitted an application to SCOPUS. We are waiting. 

M.S. Super. For my part, I can say that I greatly appreciate the product that the editors have been delivering non-stop for two years now. I sincerely believe that this is a very high-quality product, and this is a journal which is pleasant to hold in hands, it is pleasant to leaf through. It's nice to open the electronic version on the website. And it's a journal that's fun to read. I really like that you have thematic sections which positions you in a number of other scientific publications, that you have such digests about the organization of psychiatric care in different countries of the world. It is fascinating that you publish thematic issues, which, in my opinion, greatly expands the target audience. Not only with people who, by virtue of their interests or duties, read academic publications, but also with a wider range of experts, which are involved in professional discussion. It seems to me that the emergence of a Russian journal in English (an absolutely appropriate pun) is a new step in the development of the professional community. I consider this extremely important, since the skill of reading academic literature in English is currently not very in-demand among psychiatrists, and the appearance of such a journal is very valuable, as it allows them to read the abstract of an article in Russian and then immerse themselves in the full English text. And I have seen several times that you have online-first texts in Russian. This seems to me a precious addition for specialists who, for example, do not feel very confident in reading English literature, but nevertheless want to practice it. Lastly, this is a very important step forward, for the creation of a professional community and the opportunity to practice, also for the early-career scientists, in writing articles in English. We usually start publishing in Russian and when you publish your first article in English, you are responsible not only for the text, but also for correspondence with the editors, and the editors obviously do not speak your language, it is much more difficult to clarify some technical issues in these situations. Your journal in this regard is a unique opportunity for professionals, well, in a more gentle mode, to plunge into the global context of scientific and medical publications, and the most encouraging thing is that the product is really of high quality.

O.K. Thank you so much. It seems to me that there is a spatio-temporal coincidence here in a way, we have some kind of synergy between the launch of the journal and the emergence of a whole plethora of young specialists who are interested in science. Moreover, judging by the results of the survey, our professional values and educational needs miraculously coincide. Thus, I hope that we will continue together to advance both our journal and your efforts to create such a professional community that will be grounded in evidence-based medicine, develop in various directions, both clinical and scientific, and that is integrated into the international professional community. Thank you very much for taking part in our round table, and we wish all of us good mental health and every possible success. Goodbye.