Borderline patients present complex clinical features, with neurotic and psychotic aspects so that literature often define them as ‘difficult’ or ‘at limit’ for pharmacological and psychotherapeutic treatments.

The aim of this study is to introduce the unconscious skills that emerge from dreams of early sessions as an integrative method of evaluation of the possibility for a psychodynamic psychotherapy treatment.

Three patients with previous psychiatric diagnosis of borderline personality disorder with psychotic traits and related drug therapies and/or support psychotherapies, began a psychodynamic psychotherapy with the goal of recovery and resolution of intrapsychic conflicts.

The unconscious reaction to proposition of recovery, instead of only support, was defined by dreams in which the functional, valid and affective structure of patients was prevalent, instead of disturbing and psychopathological aspects.

This unconscious awareness of patients, emerged as a reaction to a valid therapeutic alliance, allowed the continuation of the psychodynamic psychotherapy, that otherwise could be not efficacious or potentially risky as described in literature.

It is possible to start a psychodynamic psychotherapy for ‘difficult’ or ‘at limit’ patients, instead of usually supportive psychotherapies, for the unconscious reaction of a valid therapeutic alliance assessed through dreams of initial psychotherapeutic sessions.

So dreams regain a relevant role in diagnosis and prognosis for these patients, often ignored with decrease of treatment possibilities.

in psychodynamic group psychotherapy it is used to divide patients in different groups with direct access and/or after preliminary individual sessions. Since 2003 our research group started a new method. Aim of this study was to assess the value of this new methodology.

we use: psychodynamic approach, 10–14 patients, open access for pathology, age, sex, starting and ending. Therapy begins with individual sessions. Therapy deals with symptoms, intra-psychic conflicts, and private issues. Meanwhile psychiatrist develops relational capacity of the patient, allowing him to enter group therapy. We continue, at the same time, with individual and group therapy, for a time different for each case. Then therapy continues in the group only, until its ends. The duration of the three steps is variable, but the total amount of time of the therapeutic approach is reduced by half in 10 years.

Efficiency of this method is divided in three points. 1) Advantages for the single patient in the group: improvement of patient privacy; decrease of transferal resistance, acting-out and drop-out; economic advantages. 2) Advantages for group dynamics: decrease of aggressive behavior and interpersonal conflicts, improving of climate group; attenuation of hierarchal levels among patients, manipulation, fabrication, selfpity, narcissism. 3) Advantages for psychiatrist: continuous monitoring of the new patient or ‘difficult’ or risky patients with decrease of countertrasfert issues.

This methodology is an effective alternative to the usual group therapy. It allows a thorough and solid approach to the patient, offering a larger possibility of patient recovery.

A ‘Sleeping beauty’ is a scientific article that becomes highly cited long after its publication.

To present this phenomenon, not limited to biomedical research.

Literature search on Google.

The most famous case of ‘Sleeping beauty’ was that of Gregor Mendel's seminal study on plant genetics that received widespread recognition 31 years after its publication.‘Sleeping beauties’ led to Nobel prizes (Herman Staudinger, Nobel in Chemistry 1953; Peyton Rous, Nobel in Chemistry 1966). They usually reflect premature discoveries that the scientific community was not ready to recognize when published. Some suppose that this has to do with most scientists’ tendency to adhere to their established paradigms. The article's authors may also be young and/or low in the hierarchy of science and their work is initially ignored. Perhaps the paper is not written in the right way for the right journal, il lacks clarity or is not adequately ‘promoted’ by its authors (e.g. in scientific meetings). Maybe the findings are difficult to be conceptually connected to the existing knowledge by a comprehensible and logical ‘bridge’. Sometimes a particular topic could be out of fashion only to see its popularity soar in future. ‘Sleeping beauties’ are thought to represent 100–1,000 articles out of nearly 1,000,000 papers published annually.

The public access granted to a lot of scientific articles makes difficult for a breakthrough paper to go unnoticed for long. However, just the quantity of today's publications could potentially ‘burry’ a great article.

This was a quasi experimental study which covered 34 Women with Multiple Sclerosis in Iran Multiple Sclerosis Society. The samples have been selected through purposive sampling and then Random assignment into intervention (16 Samples) and control group (18 Samples). Intervention was Yang style Tai Chi Chuan classes twice a week for 3 months (12 weeks). In this study demographic questionnaire, Berg Balance Scale (BBS) and Multiple Sclerosis quality of life questionnaire (MSQOL-54 scale) were used to collect data.

In the Tai Chi intervention group there was a significant improvement in mean comparison of balance score (P= 0.03) and global score of Quality of life (P = 0.00), also its subscales such as Pain (P = 0.03), Energy (P = 0.00), Overall quality of life (P = 0.01), Role limitation due to emotional problems (P = 0.04), Social Function (P= 0.03) and in Physical Health Composite Score (P = 0.03) after Tai Chi training intervention. (P< 0.05) In the control group, no statistically significant improvement was found in mean comparison of balance and Quality of life scores after 12 weeks. (P > 0.05)

The results suggested that Tai Chi Chuan could be an alternative exercise intervention to increase balance and quality of life in patient with Multiple Sclerosis.

Negative symptoms, a core feature of chronic schizophrenia, are notoriously resistant to treatment. New therapeutic strategies are proposed based on the hypothesis of a relation between glytamatergic neurotransmission and schizophrenia.

Case report.

Male patient, 51 years old, suffering from schizophrenia since the age of 22. He was stabilized on risperidone long-acting injection -37.5mg/2 weeks- and biperiden 4mg/day (due to persistent extrapyramidal tremor). His prominent symptoms were the negative ones: Affective flattening, avolition, asociality and poverty of speech. Memantine 10mg/day was added. One and a half month later the patient spontaneously admitted to spend more time with his relatives enjoying their company more than in the past. He was assessed with the Scale for the Assessment of Negative Symptoms (=96), the Scale for the Assessment of Positive Symptoms (=3), the Mini Mental State Examination (=26) and the Calgary Depression for Schizophrenia Scale (=2). Memantine was increased to 20mg/day. Two months later, affective flattening and asociality continued to improve; avolition and poverty of speech remained generally unchanged (SANS: 76, SAPS: 1, MMSE: 26, CDSS: 1). No additional side-effects were noted.

Memantine blocks the excessive influx of calcium through the activated N-methyl-D-Aspartate (NMDA) receptors which are part of the glutamatergic system. Neuroprotection of the glutamate neurons could hypothetically ameliorate several symptoms of schizophrenia that are thought to be mediated by them. In the literature the findings regarding its addition to atypical antipsychotics are conflicting, however it is proposed as potentially helpful for patients with severe residual psychopathology.

Our study was descriptive and analytic, involving 63 patients with schizophrenia.

We used a questionnaire containing demographic, clinical, therapeutic, and habits data. Smoking have been evaluated by the FTND (Fagerstrom test of nicotine dependence); with a total score ≥ 7 indicating a strong dependence.

The average age was 43 years (21- 63); the sex ratio (H/F) was 3, 09. They were singles in 52.4%. The predominant form of schizophrenia was paranoid in 65, 1% of case. The patients were smoking in 50,8% ;with an average number of cigarettes :14,62/day (0-70), the age of smoking initiation was 9.80 years. They have a family smoking history in 63,5% of cases. An attempts to weaning were revealed in 41,3% of our patients. There was an alcohol consumption in 28.9% of cases and cannabis use in 11.1% of cases. The results of FTND test : not dependents (4,8%), weakly dependents (6,3%), moderatly dependents (14,3%) et strongly or very strongly dependents (23,8%).the factors were correlated with smoking: the sex (p=0,00), the age of smoking initiation (p=0,02), the smoking motivation (p=0,00)the number of cigarettes/day (p=0,00), the alcohol consumption (p=0,00), Side effects of treatment (p=0,03) and the equivalent dose of chlorpromazine (p=0,002). ;

In Patients with schizophrenia, addictive behaviors are common especially smoking. The treatment of this psychiatric comorbidity, factor increased dependence is essential to this. There are many advanced management including substitution programs, withdrawal and CCT.

Influence lifestyle and aspects of patients and lead to depression and anxiety.

A tension headache is the most common type of primary headache. One half of patients with tension-type headaches identify stress or hunger as a precipitating factor.

This study aimed to determine the influence of multi-dimensional model of psychosocial rehabilitation on depression and anxiety in Tension Headache patients was performed.

A quasi-experimental study, two groups before and after the sampling available method on 40 Tension Headache patients in Ebenesina hospital (intervention) and 40 Tension Headache patients in Mollasadra hospital (control) was conducted in 2011. Collection scales included the questionnaires demographic, depression «Beck»’BDI-II’ and self anxious,’zong»’SAS’, which was measured before and Two months after intervention. Intervention based on a multidimensional model of psychosocial rehabilitation consists of the patient and family, physician, nurse, psychologist, and nutritionist was done in Two months. First, each client separately in aspects physical, mental, social and spiritual was assessed by team members. Then in team meetings needs of each client, progress and lack of progress in treatment, diagnosis.

Data analysis between the mean scores of depression and anxiety samples before and after the intervention group showed significant difference (p<0/001).

The multi-dimensional model of psychiatric rehabilitation care, significant differences in depression and anxiety scores in Tension Headache patients is caused.

The efficacy of long-acting injectable antipsychotics in dual schizophrenia patients has been well established.

To investigate the efficacy of long-acting injectable paliperidone palmitate(PPLAI) in the psychopathology of dual psychotic patients. To examine the tolerability profile of PPLAI in dual psychosis.

An open-label, non-interventional, prospective study was conducted in 42 dual psychotic outpatients who received PPLAI in monotherapy. We used the Brief Psychiatric Rating Scale (BPRS) to assess psychotic symptoms and the Udvalg für Kliniske Undersogelser Scale (UKU) to evaluate treatment tolerability, at baseline, and after 3 and 6 months of treatment. Prolactin levels were also determined at the time of the study inclusion and after 6 months.

Thirty-five patients were included into the study. After 6 months of treatment, patients receiving PPLAI showed a significant improvement in positive symptoms (disorganisation, suspiciousness), negative symptoms (emotional withdrawal, motor retardation, blunted affect and confusion), affective symptoms (somatic concern, anxiety and depression) and in motor symptoms (unco-operativeness, excitement). When compared to the 3rd month assessment, after 6 months, statistically significant differences were found in items 4,11,14,17 and 18. Patients receiving PPLAI had lower rates of side effects assessed by UKU Scale (asthenia, sedation, failing memory, tension, insomnia, rigidity, tremor, weight gain and sexual dysfunction). Baseline prolactin levels ranged 11–122 (mean:38), at 6 months: 20–136 (mean:38.4).

After 6 months, patients receiving PPLAI had lower psychotic symptoms, a decrease in side effects, and a significant improvement in global functioning. No changes in prolactin levels were found.

Tuberous Sclerosis Complex (TSC) is a genetic inherited disease characterized by hamartomatous growths in several organs as brain, skin, kidneys, hearth and eyes. The estimated incidence is approximately 1:6000 live births. The diagnosis is made clinically. Seizures are present in 87% of patients. Psychiatric comorbidity has been reported.

We report the clinical course of two patients with previous diagnosis of TSC. Psychiatric symptoms start in the adulthood without seizures history and absence of Subependimal Giant Cells Tumor (SGCT). The evolution and clinical features are described.

Patient 1

Married 33-years-old woman with two children affected with TSC. She was diagnosed after headache presentation in 2011. Initial MRI showed periventricular glioneuronal hamartomas. In January 2013 start with self-injurious (swallowing of objects) and autistic behaviours as well as several hospital urgency room visits. In addition, the patient presented with dull mood, emotional indifference and intellectual impairment, with no response to medication.

Patient 2

Married 43-years-old woman with a daughter affected with TSC. Diagnosis was made in 1999 and psychotic symptoms (delusional beliefs and auditory hallucinations) started in 2011 without previous psychiatric history. The MRI in 2013 shown subependymal nodules. Treatment with risperidone was effective.

Psychiatric symptoms are very often associated to the physical findings on TSC, even in adulthood diagnoses.

Psychiatric comorbidities are well described in literature. about 10-20% adult patients with TSC present clinically significant behavioral problems as self-injuries, frequently associated with SGCT. The European Expert Panel recommended regular assessment of cognitive development and behaviour and symptomatic treatment.

In addition to somatic symptoms the acromegalic patients demonstrate psychosocial and personality changes, and occasionally the cooccurrence of mental disorders.

To ascertain the psychosocial profile of acromegalic patients a cross-sectional study was designed.

Forty two patients with acromegaly and thirty two with non-functioning adenomas underwent a cross-sectional assessment regarding their socio-demographic and clinic profiles, including the quality of life (ACROQOL and WHOQOL), psychiatric morbidity (General Health Questionnaire-28) and acceptance of illness (AIS).

The acromegaly group had predominance of urban married females (59.5%) with mean age 52.31 ± 14.81, and mean duration of illness since diagnosis of 8.71 ± 8.69 years. The average ACROQOL score was 55.38±16.33. Age, quality of life and acceptance of illness were not associated factors in acromegaly versus non-functioning adenomas comparison. Seventeen subjects in both groups scored positive indicating presence of psychiatric morbidity on the GHQ-28, that is 40.48% of acromegaly patients and 53.13% of non-functioning adenomas patients. Compared to the GHQ-negative group in all subjects, the GHQ-positive group had significantly poorer quality of life in physical health domain measured with WHO Quality of Life- BREF (p<0.001) and lower scores in AIS scale (p<0.01).

Our data revealed that pituitary adenomas may affect psychosocial aspects of the patients’ everyday lives and psychiatric morbidity may influence on physical perspective of quality of life, as well as on the acceptance of illness. There is no difference in psychosocial perspective between patients with acromegaly and non-functioning adenomas in the study group.

People on the autism spectrum are particularly vulnerable to various mental and somatic diseases. Admitting the health care system is, however, a prerequisite for appropriate diagnosis and treatment of these disorders. Substantial difficulties in accessing the heath care system are reported for all autistic people, independent from their intellectual ability.

The purpose of the work is first to assess various difficulties in accessing the health care system and second to provide strategies to overcome them.

Current barriers to the health care system and possible solutions were sampled from a collaboration of autistic self-advocates and professionals in Berlin, Germany. The findings were endorsed by a thorough Internet and literature research.

A comprehensive list of barriers to health care along with recommendations to facilitate access was compiled. Strategies considering the perceptual and communicative peculiarities of autism improved access to health care for autistic adults.

Providing access to the health care system may improve diagnosis and treatment of mental and somatic illnesses and hereby enhance quality of life in people on the autism spectrum. Recognition of the peculiarities and needs of adults with autism may serve as a model for other areas in society, such as education and employment. Data acquisition in this project is of special value because it results from collaboration of an autistic self-advocacy organization and professionals working in the field of intellectual disability, considering the experiences of autistic adults in the entire range of intellectual functioning.

Neuroleptic malignant syndrome (NMS) is a life-threatening condition associated with the use of neuroleptic drugs and is characterized by a clinical syndrome of mental status change, muscle rigidity, fever, and autonomic instability. The incidence of NMS seems to has been decreasing, possibly due to increased awareness, changes in drug prescribing practices, the use of lower doses of dopamine blocking agents and atypical antipsychotics. The risk factors most consistently identified with precipitating NMS are prominent psychomotor agitation and incrementally higher doses of one or more parenterally administered neuroleptics. The use of atypical antipsychotics may be associated with: a decreased risk, decreased mortality, and atypical features of NMS.

To alert clinicians for atypical presentations of NM.

To report and discuss, based on online pubmed database, a case of a NMS with no muscle rigidity, in spite of an extremely elevated CK level, due to quetiapine.

Atypical cases of NMS without muscle rigidity and/or hyperthermia have been reported in database. With the widespread use of atypical antipsychotics, atypical presentations of NMS should be more frequent. While not yet proven, it has been hypothesized that such atypical cases are a prodrome of the disease and represent impending NMS with typical presentation.

Clinicians must be aware for this atypical presentation of the NSM since adherence to strict diagnostic criteria may lead to alternate and/or delayed diagnosis, with eventually poor outcomes. For this reason, a strong clinical suspicion based on clinical history is crucial for early diagnosis and treatment.

The aging of the population and popularisation of the long-term care institutions in Poland confronts us with the challenge of improving the quality of these institutions and to evaluate the current state of its functioning.

The aim of the study was to evaluate and analyze needs of residents living in nursing homes using the Polish version of the Camberwell Assessment of Need for Elderly (CANE).

A sample of 300 residents from three urban cities was investigating using the Polish version of CANE. Data were collected from users, rater and staff involved. Subjects ranged in age from 74 to 102 with a mean age of 83,36±5,88.

The most frequent unmet needs highlighted by users, rater as well as by staff were: psychological distress, company, intimate relationships, information, eyesight/hearing/communication and daytime activities. However, the comparison of total number of needs illustrated that overall users reported significantly fewer met needs compared with staff involved (Z=8,25; p<0,0001) and rater (Z=8,29; p<0,0001) and significantly more unmet needs comparing with staff involved (Z=6,36; p<0,0001).

This study provides us with better understanding of an individual perspective of residents living in nursing houses in Poland perceived from different points of views. The results illustrated the differences in the unmet needs perception and pointed out that taking into account only staff perception may lead to under recognition of unmet needs.

Long-acting atypical antipsychotics have been widely used in the treatment of substance use disorders and comorbid psychosis.

To investigate the impact of long-acting injectable paliperidone palmitate (PPLAI) on craving and satisfaction levels in dual psychotic patients.

An open-label, non-interventional, prospective study was conducted in 42 dual psychotic outpatients who received PPLAI in monotherapy. Craving and satisfaction levels in patients and relatives were assessed by using the Visual Analogue Scale (VAS). We used the Clinical Global Impression Scale (CGI) to assess clinical severity and global improvement, and the GAF scale to assess global functioning. 35 patients completed the study and underwent a systematic assessment at baseline and after 3 and 6 months.

After 6 months of treatment, mean craving scores decreased in patients treated with PPLAI when compared to baseline scores (4.9 vs 2.3). Mean satisfaction levels in dual psychotic patients increased (6.0 vs 9.1), and satisfaction levels in their relatives improved after 6 months (5.2 vs 9.5). Patients receiving PPLAI showed a statistically significant decrease in consumption relapses, had lower scores in CGI for clinical severity (CGISI), higher scores in global improvement (CGI-GI), and higher scores in global functioning.

After 6 months of PPLAI treatment, psychotic patients with substance use had lower craving levels. Satisfaction levels were higher in patients and their relatives. Consumption relapses decrease and patients had higher scores in global functioning.

People with intellectual disabilities (ID) make up to 3% of the general population. The prevalence of mental illness is higher among people with ID due to social and medical factors. The prevalence of Schizophrenia is 3%. Healthcare systems in Europe differ in how they meet the mental health needs of European citizens with ID. In services there are either specialists in ID or generalists to support people. In some systems, there is no identifiable healthcare model to meeting the specialist mental health needs of people with ID.

To describe mental healthcare systems in five states in Europe and the drivers of change.

A description of mental health systems for people with ID in Europe.

The mental healthcare models are diverse across Europe. There are specialist community and in-patient services in the UK and Ireland. In Romania mental healthcare in ID is often in institutional settings. In Croatia, there is an emerging provision of mental healthcare in ID in the community. In Hungary there is progress in providing community care in ID.

The mental health systems for people with ID in Europe employ a range of models. In general, there is a move from institution-based care to the adoption of community-based models. Healthcare systems are at different stages in their path to community provision. Healthcare policy and human rights legislation will shape healthcare models in mental health and ID that also rely on political will and advocacy on the needs of people with ID.

It is clear that the global community is facing a high intensity economic crisis that has spread rapidly to developed countries all around the world, with dramatic effects. It has a severe impact not only on people's health but also to their mental well being and psychology.

The objective of this study was to determine if there is a statistically significant increase in mental disorders due to the economic crisis and furthermore if there is a correlation with gender, type of job and income.

The main purpose of our research is to clarify whether the former condition and beliefs of each individual are related to how he witnesses and is affected from the crisis and if each individual considers himself responsible for what is happening.

Fifty seven (57) people, living in a suburban area, participated in the research by filling out a questionnaire of thirty (30) questions. Furtheromore, a brief semi structured interview was performed with each of the participants.

Our research depicted that the psychological impact of the economic crisis mainly affected men (65%). The percentage of those presenting with a psychological disorder was more than double amongst unemployed (34%), compared to those having a steady income (16%).

Significant relevance appears to exist between the prevalence rates of depression and demographic factors such as gender, marital status as well as economic variables such as social class, income and employment.

Over the past years multi-source-feedback (MSF) is increasingly used in healthcare systems worldwide in assessing multiple components of professional performance. Despite the current widespread available research on MSF in industry, comparatively little research exists focusing on health services. Most of the effort to date, however, has focused on developing the instruments. Insufficient attention has gone into investigating its impact on physician's performance. This study is focused on psychiatrists and change in their performance following MSF.

43 Consultant psychiatrists who have participated in two MSFs were identified. Change in MSF ratings were used as a possible indicator of feedback impact on the performance. The study compared ratings over two administrations to identify: (1) changes in self, colleagues and patients’ ratings, (2) correlation between self and others’ ratings over time, (3) impacts of feedback on self-assessments.

Significant change in colleagues’ ratings over time noted, however the self and patients’ ratings did not revealed meaningful change. Self ratings were remained uncorrelated with others ratings even after receiving the feedback. However colleagues and patients’ ratings remained correlated. Self ratings at Time 1 were predictive factor of self ratings at Time 2.

Though we identified significant change in colleagues’ ratings over time, but self and patients’ ratings did not change. The remained question is to what extent colleagues and patients’ ratings could reflect an individual's work performance. A great deal of additional research looking at MSF and impact on performance is required prior to make any guidance for beneficial feedback system.