Human being lives in temporary state, and migrates from one condition to another, by a continuing exodus, each new phase signifying the death of precedent. With this postulate we present symbolic deaths that happen in life the same person.

Fairy tales and wonderful stories present paradigms of resilience, and the resilient behavior of the characters can be understood as a pedagogical proposal for the elaboration of losses. Snow White, Cinderella, Sleeping Beauty and The Three Little Pigs are icons who have the ability to keep themselves sane in an insane environment. From narratives, drama and Bible-dramas that consider resilient states and actions it is possible to favor the acquisition of learning to solve problems in real life.

Interdisciplinary research in articles published in journals and works in the fields of Psychiatry, Psychology, Theology and Thanatology, as well as a literature review concerning the resolution of mourning through role-playing and storytelling of fairy tales and wonderful stories.

Actions like role-playing and storytelling help in the elaboration of mourning and are beneficial to implement resilience in caregivers and patients.

It is important to research on the attention given to the recovery and maintenance of the resilience of those who undergo stress, live in unsafe conditions or seek the resolution of their mourning. Further research will be useful to develop the issue.

PUT has to count periods of time of 5, 10, 15 and 20 seconds in special conditions, the measured values are retrieved statistically by a software and the final values stored in a data bank in view to reveal the evolution of the health state (vital potential) according to established significances.

The main resulted parameters are given in the example table.

HuPoTest is a powerful mental test and a training procedure as well in view to show and improve the life style and avoid

any kind of irreversible conditions/diseases. Hu Po Test can not be tricked! I.E. the PUT can not appear as he is not in reality

Within the domain of personality disorders, borderline personality disorder (BPD) has attracted the greatest attention. The literature devoted to it is more voluminous than that devoted to any of the other recognized personality disorders. This attention and large literature has more to do with the challenging nature of the condition and the difficulties attendant upon treating it, than to its frequency.

Clarify the gradual aims through psychotherapeutic work with a borderline patient. Expose the advantages, characteristics and objectives of the psychotherapeutic approaches used in BPD treatment.

A non-systematic literature review was performed in PubMed about psychotherapy and borderline personality disorder. Only original articles in English language were included.

There are currently three major psychotherapeutic approaches to the management of BPD: the psychodynamic, the cognitive-behavioral, and the supportive. There are special varieties within each: e.g., transference-focused psychotherapy (psychodynamic) or dialectic behavioral therapy (cognitive-behavioral).

Though differing in basic conceptions and in methodology, all approaches aim at the amelioration of both the symptom-aspects that dominate the clinical picture at the outset, and the personality difficulties that remain apparent after the symptoms have been alleviated.

Under ideal circumstances, the borderline patient will have evolued gradually toward a higher level of function, where (acute) management issues have been adequately dealt with or have receded into the background. Psychotherapy, individual and group, becomes the dominant intervention, with such goals as psychic integration, skills training, and the fostering of long-range ambitions relating to friendships, partner choice, and work.

Patients with schizophrenia (PWS) have difficulties in identification, expression and emotional management. Social withdrawal and difficulty of managing their relationships with others are the result of emotional hypersensitivity of PWS. Avoidance of emotional experiences may play a protective role in the short term but becomes the amplifier of emotional distress in the long term depending on the model of Barlow and Allen.

To improve identification, expression and emotional management in PWS.

PWS learn to identify, name and express their emotions, and their use in social interactions.

Groups of psychotherapy for PWS was implemented. The techniques used are those of cognitive behavioral therapy CBT (Beck) and emotional therapies (Barlow): columns Beck tailored, role-playing, psycho-emotional and breathing. Three groups of four patients participated in six therapy sessions.

In the group of PWS hospitalized, the emotional flexibility (EF) was improved. However, the nomination of emotions remained still difficult. Two groups were followed by extramural therapy. In the first, there is no difference in the scores of the FE before and after their participation. However, in the second extramural group, a half of the patients improved their score FE. In all three groups, we observed clinically less avoidance of emotional experience after working in therapy groups.

The use of emotional identification and engaged coping facilitates interpersonal communication and emphasizes the social integration of PWS. Work on emotional avoidance could prevent from maintenance and increase of emotional distress.

This paper will present a framework for a brief intensive psychotherapeutic intervention designed to address symptomatic expressions of distress that arise as the expression of unconscious conflict provoked by situations of crisis. This therapeutic approach has elements that will be familiar to any experienced therapist, but is specific in its conceptualization. What distinguishes this therapy from others is the induction and utilization of a special positive quality in the therapeutic relationship as a therapeutic aim and “curative factor” in its own right beyond its role as the substrate for a trusting relationship that underlies all successful psychotherapeutic treatments. (Viederman, 2011) This involves a specific strategy and technique designed to develop a 'benevolent transference” to effect change, sometimes to achieve symptom relief, sometimes as a precursor to meaningful insight. In this respect the relationship, considered to be a central feature of the therapy, complements understanding as a vehicle for change. A variety of interventions are described to facilitate this process and the approach will be illustrated with description of interactions with patients.

author

milton viederman md

prof emeritus weill college of medicine of cornell univ.

training psychoanalyst columbia center for training and research

The present paper is a quasi-experimental research and uses pre-test and post-test method with control group. The tool used in this paper in the pre-test and post-test stages is Cooper Smith's Self-Esteem Questionnaire. Sub-scales include educational self-esteem, family self-esteem, physical self-esteem, and social self-esteem. In this paper, group narrative therapy was held in eight weekly sessions for 90 minutes and 15 participants. The statistical universe comprises all 10-14 years old girls of Torkaman Welfare Organization in District 17 of Tehran. Multi-stage random sampling method was used in this paper. All these girls were given Cooper Smith's self-esteem test. From among the girls who had lower self-esteem, 15 girls were selected randomly as the test group and 13 ones were selected as control group. This paper has used t-student test, Levine F test for equality of variances, box test for model goodness of fit, covariance test for calculating the effect between the subjects in two control and test groups.

The main result of this paper indicates that narrative therapy has a significant effect on general self-esteem, social self-esteem, and physical self-esteem; but it has no significant effect on family self-esteem and educational self-esteem.

Previous research indicates that pet ownership and animal assistance in therapy and education may have a multitude of positive effects on humans, providing physical, physiological and psychological health benefits for patients.

Animal-assisted Therapy is a goal-directed intervention, led by a specialized professional, in which an animal that meets specific criteria is an integral part of the treatment process. There are specified goals and objectives for each individual and measured progress.

Literature has been cementing the idea that animals presence, spontaneous behaviors and availability for interaction may facilitate therapy.

It has been demonstrated that interactions with a friendly animal can result in reducing levels of cortisol and increasing oxytocin, dopamine, endorphins and phenethylamine.

The authors aim to study Animal-Assisted Therapy regarding animal-human relation, characteristics of the animals, theoretical bases, definitions, types of therapies and results.

It was conducted a review of the literature about Animal-assisted Therapy.

Recent research shows how interaction with animals can benefit individuals with a range of mental health issues, including affective disorders, anxiety, dementia, schizophrenia and trauma.

Scientific evidence on the effects is far from being consistent. It’s necessary to conduct rigorous studies to prove the efficacy of Animal-Assisted Therapy, so it could become an empirically supported treatment.

It’s also important to standardize terminology and methodologies.

Overall, Animal-assisted Therapy is an emergent field in mental health, and it can potentially be a very useful complement for the treatment of mental disorders.

There are some cases of indications of anxiety disorders (AD) that go with mitral valve prolapse (MVP). There is a reduction in the intensity of clinical symptoms after the courses of psychotherapy and anxiolitic treatment (Scordo, 2007).

To assess the psychological well-being rating and dynamics of clinical symptoms in MVP patients with AD receiving long-term integrative psychotherapy.

32 MVP patients with AD attended integrative psychotherapy (1-2 sessions per week, individual assessments). Among them 56.3% of patients received psychotherapy in addition to Alprazolam medication. Duration of psychotherapy courses ranged from 5 months to 2 years. The psychotherapy program consisted of the elements of CBT, Gestalt therapy, Interpersonal psychotherapy, and Psychodynamic psychotherapy. Psychological and clinical examinations of the patients were made before and after the therapy courses, and in the follow-up study after 2, 5, and 10 years.

78.1% of patients that attended psychotherapy demonstrated valid improvements of psychological well-being rating, the reduction of anxiety level, and the application of more effective coping-strategies. Positive dynamics of development of personality reflection, with improved skills of self-regulation, and growing awareness of actual needs and resources of personality – all this was associated with reduction of MVP clinical symptoms such as frequency and intensity of chest pain, psychogenic gastrointestinal disorders, neurogenic hyperventilation syndrome, and tension-type headache. 75% of interviewed patients were reported by the psychiatrist to be in sustained remission.

MVP patients with AD receiving psychotherapy showed a certain improvement in psychological well-being rating and characteristics of disease pattern.

Not only recipients but also donors can beaffected by liver transplantation. Only a small number of qualitative studies have explored donors' beliefs.

The aim of this study was to explore donors' beliefs about liverfailure and transplantation surgery.

The sample consisted of 16 living donors of livertransplant. An interview guide was followed during the interviews. Thematicanalysis was undertaken in parallel with interviews. Established conventions were followed foranalyzing anonymised interview transcripts inductively.

Participants’ accounts can be grouped into anumber of beliefs including beliefs about liver failure, being a donor, transplantationand organ donation. Beliefs about renal failure included diverse explanationsfor liver failure (blamingoneself and doctors, senseless drug use, stress, God’s will) and physical symptoms(yellowing, itching). Beliefs about being a donor includedreasons for being a donor (performing a good deed, being healed, not committing a sin), barriers to being a donor (beingcriticized by others, other people beingsenseless, ignorant and selfish), ways to manage these barriers (gettingloved ones’ consent, following one’s gut feeling), factors facilitating being adonor (having a few responsibilities and not having many people to leave behind). Beliefs about transplantation surgery included physical effects (pain, feeling stiff). Beliefs about organ donation included the views that organ donationshould beencouraged and awarenessshould be raised.

Somebeliefs could be interpreted in terms of existing psychologicaltheory. However, other beliefs which werenot reported before could be viewed as targetsfor psycho-educational programs.

Liver transplantation affects not only recipients ’but also donors’ lives. Little is known on the effect of liver failure and transplantation surgery on the donors’ lives.

The aim of this study was to explore the donors’ experienceof life.

The sample consisted of 16 living donors of liver transplant. Thematic analysis was undertaken in parallel with interviews during which an interview guide was followed. Anonymised interview transcripts were analysed following established conventions.

Findings showed that participants evaluated their life in terms of limitations, awareness of the need for lifestyle changes, emotional changes, changes in character and mixed relationships. Emotional changes included both negative and positive emotions (feeling reputable, feeling like being born again, rewarded in after life). Changes in character included both worsening of character (becoming half human, turning into an aggressive person) and positive changes in character (becoming more of a believer, a stronger person, a humanist). Mixed relationships included feeling supported by loved ones and doctors, reduction of burden of care because of lack of support, formation of a special bond between donors and recipients, not feeling supported by potential supporters and worsening of close relationships.

Some findings (experience of negative emotions, lack of support from others) could be interpreted in terms of existing psychological theory. Other findings (worsening aspects of character, experience of positive emotions, improvement in aspects of character, formation of a special bond, worsening of close relationships) not reported before could be viewed as targets for educational programs for donors.

Traditionally, in Ukraine as in the other countries of the former USSR, psychosocial rehabilitation was based on the medical model aimed ateliminating the manifestations of a disease and preventing relapses. Psychoeducationis a new area for Ukraine.

SQL-36, HARS, HDRS

Results, To find the most optimal for Ukraine forms and methods of psychoeducation for different mental diseases we usedthree-step algorithm: Patients’ and their relatives’ informational needsanalysis; Collecting evidence-based data and developing psychoeducationalmodules.

The most effective model of psychoeducation in Ukraine hasproved to be the one integrative bifocal, which included a successivelyrealized system of such exposures as information, psychocorrection and sociocorrection given to the patient and themembers of his family.

The most effective form of psychoeducation is a multidisciplinarybrigade: aphysician-psychiatrist, a clinical psychologist;a nurse; a social worker and a volunteer.

The criteria ofeffectiveness were as follows: stability of remission, frequency ofhospitalization, quality of life, level of anxiety and improvement of mentalcondition.

Psychoeducationnot only broadens the knowledge about the disease and increases confidence inthe fight against the disease, but also helps achieve indirect care tasks:giving opportunities for confident behavior; improving communicationskills and some other skills of everyday life; educating new strategies tosolve problems; increasing the level of social success. We consider the implementation of psychoeducationalprograms at professional, volunteer, individual and family levels to beperspective for further development of psychoeducation.

In recent years, psychoeducational interventions involving inpatients have been steadily increasing, in Italy. Yet, few studies were carried on to assess their effectiveness in preventing relapse and rehospitalization.

To assess the effectiveness of group psychoeducation on inpatients and ward atmosphere.

Case-control study, involving psychiatric inpatients. Cases: patients who attended group psychoeducation during hospital stay. Controls: patients who did not attend group psychoeducation during hospital stay. Time-to-relapse in a 6-months' fixed follow-up was studied with Cox-regressions. Ward atmosphere was recorded by nurses using an ad hoc scale developed by the Italian Istituto Superiore di Sanità, and compared with Wilcoxon's test. Statistics performed with STATA 13.0

Total sample: 82 patients, 55% women. 39 cases, mean age 42 (±13.32), 53.85% women. 43 controls, mean age 45 (±12.84), 55.81% women. No significant differences emerged in the two groups' features, that differed only by exposure to psychoeducation. Survival analysis showed no significant differences between cases (exposed to psychoeducation) and controls (not exposed) concerning time to relapse (Hazard Ratio 0.59, 95%CI: 0.13-2.75). Median ward atmosphere when patients attended the group was not different than when they did not attend it (p=0.17). Most of patients attending psychoeducation reported at discharge to have found it 'useful', they would 'attend it in the future again', and 'group topics were not difficult'.

It is not possible to say if group psychoeducation was protective against relapse after hospital discharge or not. Yet, patients' positive feedbacks encourage further research on it.

Our Psychiatry Ward (SC Psichiatria, Maggiore della Carità Hospital, Novara) has a longstanding tradition in the training of clinicians (psychiatrists, but also non-psychiatrists) about the importance of the approach in helping relationships. This tradition reflects itself in the organization of the assistance to the acute psychiatric inpatients admitted to the Ward. In addition to treatment as usual, patients have the opportunity of being involved in several group activities. The activities are proposed to them, with an approach that varies according to the patient's lifetime diagnosis, current conditions, relational difficulties, etc. In other words, different activities may be proposed to different patients, in different ways.

To describe the integrated treatment approach we use in our Psychiatry Ward.

Group activities are guided by a group leader who is supported by one or two assistants whose role is to facilitate discussion. Activities include: Newspaper Reading (everyday in the morning, 1 hour); Music Listening Group (once a week; 1 hour); Cinema Group (once a week; 2 hours and a half); Fairytale Group (on alternating days in the evening, 1 hour).

More details will be supplied regarding the theoretical background for the group, the group features/implementation, and its specific objectives.

All the group activities integrate themselves in an early rehabilitation project tailored to each patients' characteristics and needs. Briefly, their main objectives include: 1) to help patients endorse their cognitive, emotional and relational skills; 2) to offer support to the crisis they are experiencing, which led them to admission to the Ward.

Our Psychiatry Ward offers several group activities to both inpatients and outpatients. Among these, the Editorial Group involves only outpatients (who had been previously admitted to the Psychiatry Ward as inpatients) in fair psychopathological compensation, carefully selected for this long-term rehabilitation approach.

To describe the Editorial Group activity.

The Editorial Group meets once a week at the Psychiatry Ward. It involves patients, nurses and a group leader who is a Psychiatrist. The psychiatrists' and nurses' role is to facilitate the group process and the exploration of the topics discussed. Members are encouraged to discuss their opinions about tales, movies and books; to share poems, paintings, photographs. The aim of this process is to eventually develop a Ward magazine which is published quarterly.

Members' commitment is extended beyond the weekly meeting hour of the group; indeed, we have observed that patients in their free time spontaneously decide to spend time collecting material to share and drawing up the articles, which are assigned according to patients' aptitudes and preferences. A continued commitment to share daily life experiences and to express creativity, helps patients get involved in the Group, and eventually leads to something concrete and valuable to share with others, also beyond the Group. Both the leader and the other equipe members help patients listening to each others' opinions, ideas and personal experiences.

The Editorial Group helps patients improving emotional and relational skills, and stimulates cognitive resources. Moreover, it enhances creativity, promotes collaboration and stimulates curiosity.

Neurocognitive impairment constitutes a core feature of mood illness. It compromises personal and social functioning. Cognitive Remediation (CR) is accepted as an important therapeutic intervention in schizophrenia, but few studies provide data on whether the benefits extend to mood disorder.

To examine the profile and magnitude of cognitive impairments in mood disorder, review the evidence in support of CR for this population, and discuss future research directions in CR.

A literature search was conducted using Medline database. Combinations of multiple keywords were searched: mood disorder, neurocognition, cognitive remediation, cognitive training, functional remediation. Randomized-controlled trials and key studies published until 2013 were included.

We included seven studies, comprising a total of 398 participants, 71% of whom had bipolar disorder, 14% schizophrenia, 12% major depressive disorder, and 3% schizoaffective disorder. Only two studies included merely patients with bipolar disorder. It has been estimated that 30 to 60% of patients with bipolar disorder have trait-related cognitive deficits. In two studies, patients received a non-computerized programme. In the five other studies, a computer-assisted programme was delivered. The average duration of therapy was about 13.1 weeks. Effect sizes ranged from 0.33 to 0.93. Results showed that improvements in executive functioning were associated with improvements in occupational functioning.

CR in patients with mood disorder may be an effective non-pharmacological treatment option for improving cognitive functions, which may improve psychosocial functioning. Further studies are required to examine the durability of any gains with CR in these patients.

In Portugal, following the National Mental Health Plan (2008-2017), an increasing number of residential units for people with severe mental illness has been developed. There are no studies assessing their functioning.

To characterize the Portuguese residential units with high and medium support levels, their users, and the quality of care provided.

Portuguese residential units for the long-term mentally ill were assessed with the Quality Instrument for Rehabilitative Care (QuIRC) filled on-line by the managers. A random sample of service users was interviewed face-to-face with the Service User Interview.

Forty-two units (100%) were included. The majority (54.8%) was in the community, single-sex (54.8%), staffed 24 hours a day (54.8%), and had 10 or less beds (61.9%), no limit in the LOS (88.1%), and no service users in involuntary commitment (93%). All units provided access to psychologists and social workers, the majority to psychiatrists and nurses (95.2% each), auxiliaries (88.1%), and occupational therapists (73.8%). Users assessed (n=278) had a mean age of 50±11 years, and were mainly men (66.2%), with a diagnosis of schizophrenia (72.7%), a mean GAF score of 64.3±15.1, and were living in the unit for a median of 4 years.

Quality of care assessed by the QuIRC was significantly higher in community versus hospital units in the following dimensions: Living Environment (p=0.030), Treatments and Interventions (p=0.035), and Self-Management and Autonomy (p=0.019).

Residential facilities for people with severe mental illness provide better quality of care in some dimensions in community versus hospital units.

The HDP care structures are intermediate in nature providing an active heatlth care, multidimensional, structured and intensive medical care, aimed at patients with severe and complex system of partial hospitalization in pathology, as well as those patients who do not require, at a given time, income to total time, but are not subject to appropriate outpatient therapeutic gains.

1. - To analyze the profile of psychotic patients admitted to HDP.

2. - To know the effectiveness of the intervention in HDP on psychotic patients.

Prospective naturalistic study of psychotic patients (F2X.XX) entering HDP for 24 months. As main outcome variables use: PANSS score, GAF score and CASH for insight. These scales are passed on valuation and the day of discharge device.

We identified 81 patients that have been hospitalized after an acute event (67, 82.7%). From the initial sample, 22 cases were first psychotic episodes (27.2%), 46 males (56.8%) and 35 women (43.2%), Discharge statistically significant improvement in PANSS score (p objective <0.001) in the GAF score (p> o, o, o, 1) and in CASH to awareness of illness score (p <0,0,0,1).

Intervention in day Hospital on psychotic patients improves psychotic symptoms, functionality and insight.