Due to limited efficacy and side effects of pharmacological therapy in tension-type headache (TTH), alternative approaches are feasible. Neurofeedback is a noninvasive neuromodulation technique increasingly used in practice, but, however, there is limited research on its efficacy.

To evaluate the efficacy of neurofeedback in TTH and to reveal the factors moderating treatment effects.

We analyzed the data from a pilot phase of an ongoing single case design cross-over sham-controlled study. Four females with TTH underwent 10 sessions of neurofeedback and 10 sessions of sham-neurofeedback in a randomized order. Participants filled a detailed headache diary 3 weeks before, during and 3 weeks after the treatment. At enrollment, we evaluated the personality factors with the MMPI, and performed a specially developed test on psychophysiological regulation of breath.

Significant reduction of headache frequency and intensity was observed in 2 of 4 participants (responders). The responders were characterized by normal MMPI profile and, the same time, by lower baseline abilities for psychophysiological self-regulation. The non-responders had high MMPI profile (accentuation) and also higher abilities for psychophysiological self-regulation.

On the base of preliminary data, we suggest that neurofeedback may be feasible in TTH patients with lowered abilities for in psychophysiological self-regulation. Accentuation of personality traits may interfere with the efficacy of neurofeedback.

Introduciton: Repetetive transcranial magnetic stimulation (rTMS) is an effective and safety noninvasive technique for treatment of major depression disorder (MDD). There is a body of increasing evidences on the potential molecular mechanisms underlying its effectivity even in case of treatment resistant depression (TRD), however, the exact mechanism is still not clarified. Among multiple biological systems, inflammation can be a target of rTMS in MDD (Tian et al. 2020; Tateishi et al. 2020).

Here we analysed serum cytokine levels in TRD before and after rTMS interventions.

We used bilateral stimulation (15Hz for left DLPC and 1Hz on the right side) in 18 patients with TRD (5 men and 13 women; mean age=47.7±12.1 year) for 2x5 days. Blood samples were collected before the first (V1) and after the last inetrevntion (V2). Phenotypic changes were measured by Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Snaith–Hamilton Pleasure Scale (SHAPS), Insomnia Severity Index (ISI) and Stroop Color-Word Test (SCWT) modified by Golden. Inflammatory cytokines were assessed by ELISA assays.

Change of BDI and BAI scores between V1 and V2 is associated with difference of TNFalpha levels (p=0.043; adj.R2=0.42 p=0.011; adj R2=0.43). Decrease on SHAPS score has been depended on IL-6 level (p=0.027) and the interaction of TNFalpha and IL-10 (p=0.005; adj R2=0.63). Sleep disturbance and neurocognitive function was not associated with cytokine levels.

Our results confirmed the association between depressive, anxious and anhedonia symptom improvement and inflammatory mechansims during rTMS treatment. The study was supported by the OTKA 151513 grant.

Vagus nerve stimulation (VNS) is a neuromodulation technique approved for Treatment-Resistant Depression (TRD). Evidence regarding its long-term efficacy and safety is still scarce.

To descriptively report a case series of 3 patients undergoing adjunctive VNS for TRD with an over 10-year follow-up.

We investigated outcomes of clinical interest in patients with ongoing VNS for at least 10 years after the device implantation. They had participated in a larger single-arm interventional study conducted at the University Hospital of Padua. They were diagnosed with chronic unipolar (1), recurrent unipolar (1), and bipolar (1) TRD.

Our 3 cases had an average 14-year history of psychiatric disease before surgery. Afterward, all subjects achieved clinical remission within two years. 2 patients experienced relapses within the first 4 years of treatment (respectively, 1 and 2 episodes). The other case showed a recurrent trend of brief relapses every two years. Only 1 individual needed to be admitted to the psychiatric unit once. None of them committed suicidal attempts. Prescription of antidepressants remained almost unchanged after the first two years. 2 individuals improved and 1 maintained their working position. Common adverse events were voice alteration (3/3), neck pain (2/3), and cough (2/3).

Very few cases of 10-year VNS for TRD have been reported so far. For our subjects, VNS was most likely to have a major impact on the clinical course of the disease. This treatment can be a safe and effective adjunctive intervention in a subgroup of patients with TRD.

Although there are very effective treatment approaches for Attention Deficit Hyperactivity Disorder (ADHD) available, the clinical management has its limits making new treatment modalities a necessity. Evidence suggests that low frequency repetitive transcranial magnetic stimulation (rTMS), improves hyperactivity, impulsivity, and attention deficit of individuals with ADHD.

The aim of this case study is to present the effectiveness of rTMS on hyperactivity, impulsivity, and attention deficit of an individual with ADHD.

This is a case study of a 22 year old male diagnosed with ADHD. The protocol applied was 2 weeks of daily rTMS sessions. This involved repetitive TMS to the right dorsomedial prefrontal cortex (10 Hz, 3.000 pulses, 120% motor threshold) to treat attention deficit, hyperactivity and impulsivity. Assessments were conducted using Adult ADHD Questionnaires, the Jasper and Goldberg questionnaire and WHO self- reported scale at baseline, 1 month and up to 3 months follow up.

The patient showed overall improvement in scores in both ADHD scales with scores dropping more than 50 % in both scales from pre treatment to 3 months follow up. No side effects were recorded during therapy

Our findings suggest that the use of rTMS therapy in individuals with ADHD, is an efficacious and safe therapeutic treatment option.

Electroconvulsive therapy (ECT) is a current, relevant treatment for severe mental illness. In this article we describe our experience on ECT in a public hospital in Chile.

Describe a 34 patients’ cohort who received ECT and their outcomes.

Data was extracted from ECT records between 2018-2020, patients’ evaluations before and after ECT, and case files. Data was then analyzed and described.

ECT was received by 18 males and 16 females. Age ranged from 19 to 73 years (41 average). More than 75% had 12 or more years of education. Patients’ diagnoses and indications for ECT are shown in Figures 1-2

The CGI-SI scale was applied to subjects before treatment, and 85% had a score of 5 or more. On average, patients received 8.7 ECT sessions. Right unilateral electrode placement (RUL) was preferred initially for 94% of patients. Brief pulse width (0.3ms) was most commonly used (76%). Seizure duration averaged in 29 seconds. Adverse reactions presented on 32%, most being mild. One treatment had to be stopped due to confusional symptoms post ECT. After ECT, 91% of patients improved according to CGI-GI scale. 55% were assessed CGI-GI 1 “very much improved”. MoCA scale was also evaluated, showing a 2,1 point gain.

Schizophrenia and psychosis were the most frequent diagnosis and indication for ECT. RUL and brief pulse width were the preferred settings. This cohort suggests that ECT had an impact on markedly ill patients, based on CGI and MoCA scales.

A physicians work is closely related to patients and the understanding of their problems. The use of psychotherapeutic methods is a factor for successful care (Swanson, 1994). At the same time burnout is a syndrome that can affect the health of doctors themselves thus reflecting on the quality of care they can provide (Lloyd et al, 2002).

To investigate the use of psychotherapeutic methods in family physicians work in Latvia and the association between burnout rates and the use of these methods in practice as well as different demographic and work-related factors.

A cross sectional study was carried out. An anonymous online form that contained questions about the demographic data, psychotherapeutic methods/techniques mastering and usage and questions from the Maslach Burnout Inventory was sent out to the publicly available email addresses of family physicians in Latvia. The collected data was analyzed using Microsoft Excel and IBM SPSS software.

Together 54 responses were received from all regions of Latvia. The analysis found association between work hours per week, patients seen per week, usage of psychotherapeutic methods and burnout. More hours per week was associated with higher rates of depersonalization (p=0,014) and burnout (p=0,010). More patients per week was associated with higher rates of burnout (p=0,024). Being unsure if they were using any psychotherapeutic methods was associated with higher rates of depersonalization (p=0,028).

The data obtained allows a better insight in to the usage of psychotherapeutic methods, everyday work and the association with burnout rates in family physicians.

Mindfulness-based cognitive therapy (MBCT) is a third wave cognitive-behavioral therapy (CBT) that incorporates meditation exercises in the classical, structured intervention. Mindfulness has been associated with psychological well-being, and certain symptoms that occur in major depressive disorder (MDD), e.g. worries, ruminations, ideas of incapacity or self-devaluation, are considered potential targets for MBCT.

To evaluate the current level of evidence for the MCBT efficacy in MDD.

A literature serach was performed in the main electronic databases, targeting clinical trials that evaluated in a randomized manner the efficacy of MCBT versus active comparators or placebo in patients with MDD.

MBCT was efficient in a 10-week randomized controlled trial (RCT) versus standard treatment, and it decreased ruminations, increased patients quality of life, mindfulness abilities, and self-compassion. In another randomized, 8-week RCT, MBCT prevented relapses in MDD, with similar rates when compared to psychoeducation and standard treatment. A 26-month follow-up study evidenced the persistence of symptoms improvement detected after 12 months of the trial, when compared to active control group and treatment as usual. MCBT was compared to cognitive therapy in a randomized 8-week trial, and both treatments had similar efficacy in MDD relapse prevention.

MCBT may be an useful adjuvant to the current treatment in acute MDD, but it may also decrease the risk of relapse after psychotherapy termination.

Psychotherapy of patients suffering from schizophrenic disorders remains controversial. There are promising descriptions of psychothereputic interventions in combination with pharmacological treatment. Some empirical studies show that different forms of psychotherapy are effective. However, there are few models to combine different psychotherapeutic strategies in a comprehensive way.

We here propose a model of integrative psychotherapy that is based on the therapeutic alliance and the general principles of understanding and communication. It comprises interpersonal, behavioral, psychodynamic, and existential elements.

Theoretical principles of different psychotherapeutic schools are applied hermeneutically to a case of schizophrenia. Thus, general methods of psychotherapy gain contextual meaning by the analysis of an individual narrative. The patient himself assessed and approved his case report.

After remission of the acute symptoms, integrative psychotherapy played the major role in the recovery of a young musician. It is shown how the therapeutic alliance and communication in a general sense interacted with behavioral, cognitive, psychodynamic, and existential techniques. It is demonstrated narratively how recovery was facilitated, adjunct to pharmacological treatment, by method-integrative psychotherapy. Basic cognitive-behavioral techniques ensured at first the stabilization of the patient. Then psychodynamic remembering, repeating, and working through became possible. Finally, existential topics and creative solutions dominated the sessions.

Psychotherapeutic method-integration is necessary to treat patients with various mental disorders especially schizophrenia. We propose an ABCDE-Model that comprises the following principles: Therapeutic alliance (A); behavior change (B); cognitive reflection on dysfunctional meanings and beliefs (C); psychodynamic remembering, repeating, and working through (D); and existential understanding and communication (E).

The relationship of alexithymia with gambling addiction is not obvious, but it is present, as evidenced by the results of many studies. Alexithymia is likely to associate with gambling as a coping behavior to increase emotional arousal and avoid negative emotions, according to the affect dysregulation model. Alexithymic individuals experience the same spectrum of emotions as ordinary people, however, from the standpoint of psychology, psychiatry, unexpressed emotions are repressed into the subconscious, and their bodily manifestations accumulate.

We plan to conduct research to improve the medical and psychological support of patients with pathological gambling due to the presence of alexithymia.

A systematic search of the literature was run in the major reference databases including PubMed, Cochrane Database for Systematic Review, Web of Science, Scopus until 2019. All studies assessed alexithymia with the Toronto Alexithymia Scale while gambling problems were assessed mostly with the South Oaks Gambling Screen.

We assume that for pathological gamblers, specific psychotherapeutic techniques like body-centered psychotherapy could help them to differentiate feelings from bodily sensations.

The results highlight the importance of taking in the relationship between alexithymia and pathological gambling. Further studies are needed to widen the knowledge of this association.

Despite existentialism positing that existential concerns are universal, research into the existential issues related to addiction remains scarce. An existential model of addiction is lacking.

This research aims to develop an existential model of addiction, conceptualising the development of addiction through to authenticity.

A scoping literature review was carried out using PUBMED, reference lists and internet websites.

Psychopathology, from an existential point of view, occurs as a result of the avoidance of the existential givens which are death, freedom, existential isolation and meaninglessness. In this model, addiction is positioned as a coping mechanism to deal with the existential or neurotic anxiety which arises from facing or avoiding the existential givens. Addiction is defined as being-with-drug; a state in which our inherent relation to others is replaced by a relation with a substance. This state is understood from the ontological, axiological, ethical and praxeological levels, shedding light on the phenomenological experience of addiction. The existential dilemmas around meaning, loneliness, death, freedom, guilt and control while living with addiction are discussed. Finally, existential crises, boundary situations and secondary suffering are seen as the main motivators to overcome addiction.

Phenomenological and existential research support the fact that existential issues are relevant to addiction. This model explains the relationships between existential concepts and addiction, while providing a framework for clinicians to explore and address these issues with patients.

Emotion regulation is a key world to understand many human behaviors. Preschool children can exhibite disturbing behaviors that could interfeer with their integration, development and learning abilities. One way to understand these behaviors is their “immature” emotional regulation process. Helping children acquiring this ability can help to solve these disturbances’, which can lead to mental health problems.

To experiment with a new acceptance and committment therapy protocol in preschool children

It is a qualitative interventional study that relies on issues to enable the recognition and regulation of emotions. a protocol was implemented which consists of activities and techniques useful to help children recognize, regulate and accept their emotions, with the support of the educator.

All six selected children accepted to undergo the therapy till the end of the eight sessions. at fisrt, they were enable to recognise some emtions. it was the most difficult for them to recognise body expression of emotion. they had also difficulties find the different worlds to express them and to enact them.Throw different activities, we tried to help children visualize their emotions, imagine them under different faces and play with them. Children were introduced to mindfulness and emotional regulation technics. After One month of the intervention, children were still able to recognize emotions and to propose technics to regulate them. their score on the CBCL were below 70 one month after the intervention.

Even at an early age of 4 years, ACT seems to be possible and helpful for children.

Contextualization: Emotional experiences of psychologists related to the care of suicide crises are important since the health professional has been trained to save lives. It makes him apprehend the aggressive side of suicide and symbolize it as an attack. When the patient’s desire to liveceases, the professional may feel confused, since his/her profession/vocation was confronted.

AIM: To explore and interpret the meanings of emotional experiences reported by psychologists who care for patients in suicide crises.

Strategies: clinical-qualitative design, semi-directed interviews with open-ended questions in-depth. Six clinical psychologists from a Brazilian city participated, with a sample closed by information saturation. Interviews audio recorded, full transcribed and categorized by Qualitative Content Analysis. Results were peer-reviewed in meetings in a Qualitative Research Study Group.

Findings: Three emerging categories - (1) Ambivalent emotions as challenges for clinical management, (2) The non-paralyzing experience of emotions, (3) The management that is learned in practice.

Considerations: assistance to patients with a suicidal crisis can generate ambivalent emotions, not always paralyzing. When recognized and elaborated can assist in clinical practice. It can be tools that will support qualified approaches, especially in relation to suicide. As a public health problem, it demands a combination collective actions with effective individual clinical approaches.

Joseph Pratt, a sanatorium doctor, at the beginning of the 20th century began to organize groups of patients in order to transmit information about their illness, observing that those who came had a better evolution. In the twenties, Jacob L. Moreno, would make the leap towards mental health, transferring the group format to the treatment of mental disorders. At the same time, Lazell and Marsh began to carry out psychoeducational groups with admitted schizophrenic patients.

Present experience of a psychotherapeutic group in a brief psychiatry hospitalization unit.

Non-directional, voluntary group, with daily frequency and 30 minutes duration. Between 8-15 patients participated. Participation in the group required compliance with 2 rules: respecting word turns and speaking from one’s own experience. The sessions were organized in three parts, 1. Opening of the group: the rules are remembered and we welcome new patients. 2. Group: dialogue between patients 3. Group closure: summary of the session and dismissal of discharge patients.

The following topics were addressed: - The experience of admission; traumatic vs restorative. - The difficulties they expected to encounter after discharge. - Aspects related to family bonding, between equals and couples. As difficulties we find: - The heterogeneity in the symptoms of the patients. - Voluntary participation in the group. - Conflicts reactive to non-compliance with the rules.

Group therapies in brief hospitalization units have great therapeutic potential.

No significant relationships.

Patients with dissociative identity disorder (DID) present two or more identities, where one of them is the main one. Although it is a widely questioned diagnosis, it is currently found in the main DSM-5 and ICD-10 diagnostic manuals.

Present a case of dissociative identity disorder.

46-year-old woman who attended the CSM referred for her MAP due to anxiety-depressive symptoms. Throughout the interviews the patient brings up to 4 identities with alterations in memory, consciousness, multiple dissociative symptoms, sound thinking, constant fluctuations in mood. She is separated, has two children, takes care of them, although she is not able to maintain work functionality. The patient is seen once a week for 45 minutes. Psychotherapeutic treatment is carried out, the objective of which is to establish a safe therapist-patient bond to favor the integration of their parts, and pharmacological treatment, which was carried out with haloperidol, lorazepam and desvenlafaxine.

Throughout sessions, the anxious symptoms diminished, being able to carry out psychotherapeutic work. Dissociative symptoms were slightly reduced, partially integrating some of the identities. There was a slight stabilization in mood and decrease in psychotic symptoms.

There is no well-established treatment for DID. Combined therapy (psychotherapy and pharmacological) may be an option for these patients. The therapeutic framing of the sessions, working the link, and the low-dose antipsychotic treatment were favorable.

dissociative identity framing link

HIV infection is currently considered a worldwide pandemic.

The objective of this paper is to outline the profile of HIV – positive patients in intensive care units, regarding the psycho-emotional and viral parameters.

We realized a retrospective study for a period of 36 months, evaluating HIV positive patients in intensive care unit in the “Sf. Parascheva” Infectious Diseases Clincal Hospital Iasi, Romania.

From 1st of Janury 2011 to 31st of December 2013, the HIV/AIDS Regional Centre of Iasi recorded 2649 hospitalizations, of which 18 cases required intensive medical care, 10 males and 8 females. The number of days of hospital admission varied between 4.5 and 32 days in the Intensive Care Unit. Initialy the psychological interview was conducted for 16 of the 18th patients, 2 cases were with severely deteriorated health status that didn’t allowed communication. From them, 7 survived and they were evaluated at discharge from IIntensive Care Unit and also monitored long term, that revealed an increase in adherence to Antiretroviral Therapy and a change in lifestyle.

HIV positive patients that requires intensive care showed a marked immunological collapse due to abandonment of the therapy or late detection. In order to fully accomplish the needs of the HIV positive patient, the infectious diseases specialist must collaborate with the psychologist.

Suicide remains a major problem throughout society. Unfortunately, recommendations for the treatment of suicidal clients are often presented at a general level, without providing adequate detail that could guide the practicing clinician.

The review explains three main strategies that can be used to helpr educe the risk of suicide among depressed adults.

Method: The review identified three themes derives from an integration of 30+ years of clinical experience working with depressed outpatients combined with a comprehensive review of recent journal articles on depression and suicide.

First, clients may become suicidal when they focus on unfortunate events from their recent or distant past, resulting in tendencies for rumination and guilt. Therapy can help clients cultivate an attitude of contentment, promoting self-forgiveness and a sense of accomplishment. Second, suicidal clients often focus on their current struggles, frequently involving financial problems, interpersonal conflict, and social isolation. Therapy can help clients to embrace life through planned activities, reconnecting with loved ones, and repairing damaged relationships. Third, clients may struggle because of hopeless views of their future, feeling trapped in a desperate situation with no possible solution. Therapy can help clients look to the future with a more optimist attitude and a sense of control.

Clients can learn to search for realistic solutions to their problems, developing a renewed sense of optimism and empowerment. The risk of suicide can be reduced when therapy helps clients reduce guilt and worthlessness, increase meaningful social bonds, and instill realistic hope for the future.

No significant relationships.

PPalliative medicine is aimed at achieving the best possible in a particular situation the level of quality of life of the patient.

The reaction of grief is one of the strongest and most painful human experiences.

There were 120 cancer patients observed. The reaction of grief consists of 4 stages: shock and protest - numbness, disbelief and acute dysphoria; absorption - acute longing, search and anger; disorganization - a sense of despair and acceptance of loss and decision.

The initial reaction of grief - shock, emotional numbness and disbelief. The excitement is most pronounced within about two weeks, followed by symptoms of depression, which reach its peak 4-6 weeks. Eventually, the former intense pain of severe loss begins to subside. In addition to the reaction of grief, there is a pathological, which is divided into suppressed (inhibited), delayed (delayed) and chronic. The role of the psychotherapist at this stage is to provide psychological support and assistance to both the patient and his environment to cope with this situation.

The principle of the concept of palliative care is the need to ensure the psychological comfort of the patient.

The NICE guidelines recommend for mild major depression a range of low-intensity psychosocial intervention of proven effectiveness, as Interpersonal Counselling, and a stepped-care approach.

To assess feasibility and effectiveness of Interpersonal Psychotherapy interventions for the treatment of depression in a consolidated Collaborative Stepped Care Model between primary care and mental health specialists.

103 patients were referred by their PCPs to the Consultation-Liaison Service of Bologna and Modena. Of them, 78 were included in the study and administered self-report instruments and interview, including screening depression, anxiety and daily functioning. Patients were asked to choose one of the available treatment: 1) Interpersonal Counseling (IPC) 6-8 weekly meetings for 30 minutes; 2) IPC for Depression in Primary Care 3 sessions of 50 minutes; 3) a guided self-help intervention. Follow-up were planned at 1, 3 and 6 months. Both patients and PCPs provided a feedback about intervention’s satisfactions.

At the baseline, 39.4% of the patients presented a minor depression/major depression mild and the large majority (75.0%) of them chose IPC, while none of them chose the guided self-help intervention. At follow ups the mean PHQ-9 significantly decreased compared to the baseline (p<0.001); daily functioning increased (WSAS: p<0.001) and anxiety traits improved (STAI: p<0.001). Patient’s general satisfaction with the service received was high (GSQ: 85.9±15.0) as well as PCPs, 62.7% of them expressed high satisfaction for the intervention.

The study emphasised that IPC is an effective and feasible treatment very well suited to the primary care setting for an optimal management of depression.

The Athens multifamily therapy project (A- MFTP) provides systemic multifamily group therapy to youths who experienced a first psychotic episode (FEP) and their families.

The participants were recruited from the ongoing longitudinal Early Psychosis Intervention Study –ELPIS, Athens FEP Project, which aims to investigate the involvement of genetic and environmental determinants on psychosis risk.

A group of five families with a child who had experience FEP, attended two multifamily group sessions per month, in the time period from September 2017 to Jun 2018. Parents and offspring participated to the sessions, which were conducted by two co-therapists. Assessment of patients’ psychopathology was based on PANSS at baseline, end of therapy and 6-month follow-up. All participants fulfilled an instrument assessing family factors (SCORE-15) and the Reflective Functioning Questionnaire (RFQ) at the same three time points. Furthermore, participants were asked to give written opinions regarding the therapeutic process at the middle phase, the end of therapy and six months follow - up.

A qualitative analysis identified the emerging themes and patterns, focusing on the language and the meaning constitutes. Communication techniques, emotional processing and problem solving were the main learnings for the members of the group. They highlighted the impact of the group processes on family communication and individual understanding, while the development of a “new family” emerged from the group relationships.

A- MFTP seems to be a promising service aiming to improve mental health and wellbeing of participants, to contrast chronicity and to contribute to early intervention services for psychoses in Greece.

About 30% of individuals in ultra-high risk (UHR) of psychosis develop overt psychosis within 3 years, and about 40% of those who don’t will keep experiencing ongoing attenuated psychotic symptoms and persistent functional disability. During this prodromal period, it’s possible to prevent the transition to a first-episode psychosis.

To conduct a short review of literature on the role of cognitive-behavioural therapy (CBT) in preventing psychosis in ultra-high risk patients.

We performed a literature search on PUBMED, using the query: “Cognitive Behavioral Therapy” [Mesh] AND “psychosis” AND “prevention”. We focused on data from systematic reviews, clinical trials and meta-analysis published on last 5 years, either in English or Portuguese.

Some authors claim cognitive-behavioural therapy (CBT) as first-choice treatment in clients with ultra-high risk (UHR) for psychosis. CBT aims to normalize extraordinary experiences with education and to prevent delusional explanations. On a Japanese study, the total score of Positive and Negative Syndrome Scale (PANSS) significantly improved on post-intervention and follow-up assessments, with large effect sizes observed. Teaching families to apply CBT with their offspring may bolster therapeutic gains made in time-limited treatment. CBT showed an 83% probability of being more effective and less costly than routine care.

Patients with UHR for psychosis can be treated successfully with CBT to postpone and prevent the transition to a first-episode psychosis. CBT for UHR has been included in the European guidelines and awaits dissemination and implementation in mental health services.