The author has not supplied his/her declaration of competing interest.

According to Jaspers, with the term of choice you should not be understood the possibility to choose between objects but freedom as a choice for themselves. Because I choose, then I am; in fact, I feel my freedom in my mind. Choose what is best for the psychiatric patient in different contexts (relational, occupational, social, therapeutic) is the ability to act. The best practices provide that psychiatrists, nurses, social workers, rehabilitation professionals are committed to enhancing the capacity to choose but the legal protection measures are likely to be a contradiction.

We try to explore the theme of choice based on the capacity to act or failure to act from a phenomenological approach.

Through some concrete cases, extrapolated from clinical practice, highlight the contradictions between enunciation of principles and procedures for responding to the problems of psychiatric patients who are not able to choose.

Protections of health and individual freedom are the weights of a balance poised, since there is uncertainty about the anthropological paradigm of the mentally ill.

The authors have not supplied their declaration of competing interest.

The factors contributing to a challenging interaction between the roles of patient and physician may come from several sources. Each interrelation has its own modus operandis in which one of the individuals may not condone the persona the other individual is portraying. A mental illness or diagnosis is often stigmatised by the burden of stereotypical bizarre associations. That means the patient is generally not guilty and this is not another label they should carry. Though the mental health professional should be impervious to this, some degree of discomfort may throw some shadow on the clinical mediation of the interview and management of the pathology.

To provide an overview of what is beyond the label “difficult patient” in mental health care.

Evaluation of conflicts inside the patient-illness-physician triad.

Search for articles in Pubmed, Athens, Google Scholar databases, along with the hospital library.

Characteristics of problematic interactions in psychiatric care were described consistently across our references. Causality for these difficulties is vast and surpasses the patient's behaviour. Plus they are not unique in psychiatry. They can be explained by individual, interpersonal, and social factors.

Situational issues, along with patient and physician characteristics, modulate and frame what should potentially be a productive encounter. To become aware of what contributes to difficult clinical encounters and to be prepared to address them while cultivating good interpersonal communication skills is fundamental.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Both Minkowski and Levinas introduced in France phenomenological thinking, psychopathology and metaphysics, respectively.

It is in this context that interested raise the similarities and differences in relation to the study of time these authors in their link to the construction of the self (soi-même).

Both authors take up the relevance of temporality in the construction of the psychic, overtaking Husserl's phenomenology, the distinction between thinking and intuition discursive and theoretical thinking and sensitivity.

Comparative analysis of the problem of time and its relation to the psyche, Le temps vécu of Minkowski, Autrement qu’être of Levinas.

You can set a break with Husserl's phenomenology, inspired by the philosophy of Bergson, based on the living back in the studio. At the same time, among the authors reviewed, there is an irreconcilable discrepancy in the notions of activity and passivity in relation to the construction of the self (soi-même).

Phenomenology applied to the psychic needs to return to its original inspiration to go beyond a methodological rigid reading, which ends up betraying its spirit, which leads her to forget the living world in its complexity.

The authors have not supplied their declaration of competing interest.

Eugène Minkowski is one of the great authors of structural phenomenological psychiatry. However, it has stressed only its influence on the study of schizophrenia, however, the scope of its investigations is much coarser, while addresses issues that attempt to illuminate the way they are set life and humans.

It is interesting to pose as the author emphasizes the importance of intuition, on more than one level, giving an epistemologically worthy rank in the constitution of the self (soi-même), in psychopathology and even in the ontology.

It is shown that in Minkowski research on intuition it appears as a study of a symptom called autism, as a psychopathological diagnostic method called empathy, and even as an ontological understanding that purpose of the study time.

Reconstruction of the uses of the notion of intuition in the work of Minkowski.

Three ways clearly appear in different planes but complementary, pointing not only to a clinical trial, but take a glimpse metaphysical aspects.

The conclusions aimed are highlighting how Minkowski think intuition not only as a dignified way to understand the suffering, or establish a knowledge, but necessary for a clinic and even an approximation of what we are.

The authors have not supplied their declaration of competing interest.

Alexithymia consider a cluster of cognitive and affective characteristics that include: inability of recognizing and describing emotions, difficulties in distinguishing feelings and physical sensations during emotional arousal, narrowed capacity for imagination and externally oriented cognitive style. Several studies links alexithymia with increased risk for physical and mental damage. Symptoms of alexithymia are documented in persons who develop PTSD in response to different types of traumatic events.

To examine alexithymia in war veterans.

To determine whether alexithymia is significantly more present in war veterans with PTSD.

Cross-sectional study of 205 war veterans tested by Harvard Trauma Questionnaire and by Toronto Alexithymia Scale (TAS-20).

Out of 205 war veterans 89 (43.4%) of them have alexithymia. Significantly more veterans with PTSD (78 or 75%) than without PTSD (11 or 10.9%) has alexithymia (Chi2 = 88.955, P < 0.001) was found a statistically significant difference between the two groups in the total score of alexithymia (t-test = −10.676, P < 0.001) statistically significant difference was found in all three domains of alexithymia.

Alexithymia is significantly often in war veterans with than without PTSD.

The authors have not supplied their declaration of competing interest.

Sleep disorders such as nightmares and insomnia are among the most frequently reported symptoms in patients with post-traumatic stress disorder (PTSD).

To assess the prevalence of residual sleep disorders in military personnel with PTSD.

A cross-sectional study was conducted and included 25 military consultants meeting the criteria of DSM-5 for PTSD. Sleep disorders were assessed using the insomnia severity index (ISI).

The mean score of the ISI was 14. Fourteen percent of the participants (n = 21) reported difficulty falling asleep. All patients reported difficulties staying asleep. Nightmares were reported by 48% of the sample (n = 12). All patients were under hydroxyzine at dosages ranging from 25 to 50 mg per day. More than half of the sample (n = 18) was under a combination of benzodiazepine and hydroxyzine. Seventy-one percent of patients (n = 15) considered that their sleep difficulties significantly disrupted their daily lives.

Insomnia is one of the most frequent and persistent symptoms in PTSD patients. These sleep disorders can impede remission and may be due in part to co-morbid depression.

The authors have not supplied their declaration of competing interest.

Patients with post-traumatic stress disorder (PTSD) presents often with several concomitant physical and mental health problems. Recent evidence suggests that pain is one of the most commonly reported symptoms in patients with PTSD, regardless of the nature of their traumatic experience.

To evaluate chronic pain in patients with PTSD in a Tunisian military sample.

Transversal descriptive study of a sample of 22 patients treated for PTSD in the Principal Military Hospital of Instruction of Tunis during the period between August and October 2016.

The PTSD Checklist for DSM-5 (PCL-5), Hospital Anxiety and Depression scale (HAD), and the Brief Pain Inventory Short Form (BPI-SF) were administered for patients.

All the patients of the study were male. The mean age of the sample was 29.6 years. Fifty percent presented with a co-morbid major depression and 59.1% with chronic pain symptoms. Locations of chronic pain were as follow: limb pain (69.23%), back pain (38.46%), headache (30.76%) and torso pain (7.69%). Sequelae from combat-related trauma were present in 31.8% of cases.

The results of this study illustrate a high rate of chronic pain symptoms among PTSD patients. This suggests that closer attention should be given to the interaction of medical problems, especially pain, with PTSD symptomatology in clinical management and in future research.

The authors have not supplied their declaration of competing interest.

Maintaining self-esteem is a fundamental human motivation. Trauma may lower self-esteem, which contributes to the development and maintenance of Post-Traumatic Stress Disorder (PTSD).

Assessment of self-esteem in Tunisian military patients suffering from PTSD. Study of correlation between the severity of the PTSD symptoms and the rate of self-esteem.

Transversal descriptive study of a sample of 22 patients treated for PTSD in the Tunisian Military Hospital during the period between August and October 2016.

The PTSD Cheklist for DSM-5 (PCL-5), Hospital Anxiety and Depression scale (HAD), and the Rosenberg Self-Esteem Scale were administered for patients.

All the patients assessed were male. The mean age of the sample was 29.6 years. Fifty percent of the patients presented with a co-morbid major depression. Based on the score of the Rosenberg Self-Esteem Scale, patients had a self-esteem, which was very low in 45.45% of case, low in 45.45% of cases, average in 4.54% of cases and high in 4.54% of cases. The results also showed that lower levels of self-esteem are significantly correlated to the severity of the PTSD symptoms as measured by the PCL-5 score.

This study highlights the magnitude of self-esteem deficiency among patients suffering from PTSD. It remains unclear as to whether the relationship between trauma and depression is consistently mediated by a negative cognitive schema, such as low self-esteem, or whether trauma influences mood independently of low self-esteem. Further studies are required.

The authors have not supplied their declaration of competing interest.

Data that assess the co-morbidity between post-traumatic stress symptoms and autism spectrum are scarce. Nevertheless, some authors suggested that subjects with autism spectrum disorder (ASD), due to their difficulty in understanding the codes of communication, empathy, expression, are lower resilience to traumas.

The aim of this study was to explore in a sample of parents of children with epilepsy, the presence of correlations between the symptoms of post-traumatic stress and adult autism subthreshold spectrum.

Seventy-seven parents completed the Trauma and Loss Spectrum Self-Report (TALS-SR), specifically modified for one's son epileptic disease, and 72 parents completed the AdAS Spectrum (Adult Autism subthreshold Spectrum).

Eight subjects (11.1%) presented a total score ≥45 at the AdAS Spectrum, corresponding to the satisfaction of a symptomatic ASD criteria and indicative of the Adult Autism Spectrum subthreshold. More specifically, a total score ≥45 was found in 7 (15.9%) of mothers and 1 (3.6%) of the fathers, with no statistically significant differences between the two groups (P = 0.139).

Noteworthy correlations between TALS and AdAS, emerged only in the subgroup of the fathers. In particular, a relevant number of moderate to good correlations emerged between the Domain II (reactions to the events of loss) of the TALS-SR and the AdAS Domain III (non verbal communication), Domain VI (restricted interests and ruminations) and total score.

Results indicate that this peculiar psychopathological model could lead to increased vulnerability to effects of the trauma, in particular in male.

The authors have not supplied their declaration of competing interest.

PTSD is extremely common in patients with fibromyalgia (FM) with rates up to 57%, and it often correlates with increased severity of the disease.

The aim of this study was to investigate the presence of PTSD, diagnosed according to DSM-5 criteria, and of Post-Traumatic Stress Spectrum symptoms in a sample of patients with FM.

Sixty-one patients, 7 males and 54 females, with FM, diagnosed according to American College of Rheumatology (ACR) at the Unit of Rheumatology of A.O.U.P clinics, were assessed by: SCID-5; Trauma and Loss Spectrum Self-Report (TALS-SR); Adult Autism Subthreshold Spectrum (AdAS Spectrum).

Patients with FM with full and partial PTSD reported a significantly higher number of losses and potentially traumatic events in the TALS-SR than patients without PTSD. Significantly, higher AdAS Spectrum scores in almost all domains were reported in patients with PTSD with respect to those with partial or without PTSD. Moderate to good correlations were highlighted amongst most of the TALS-SR and ADAS-Spectrum domains.

Significant DSM-5 PTSD rates emerged in our sample of patients with FM. Significant correlations were found between Adult Subthreshold Autism Spectrum and Post-Traumatic Stress Spectrum, corroborating recent hypotheses that indicate autism spectrum symptoms as vulnerability factors for PTSD.

The authors have not supplied their declaration of competing interest.

Increasing literature suggests the need to explore PTSD and post-traumatic stress symptoms among parents and caregivers of children with acute and chronic illnesses but scant data are available on epilepsy.

The aim of this study was to estimate full and partial PTSD rates among parents of children with epilepsy according to DSM-5 criteria. Further, aim of this study was to examine eventual gender differences between mothers and fathers.

One hundred and thirty-eight parents, 91 mothers (65.9%) and 47 (34.1%) fathers, of children diagnosed with epilepsy were interviewed using the SCID-5.

Full and partial DSM-5 PTSD were reported by 10.4% and 37.3% of patients, respectively. Significant gender differences, with the mother more affected, emerged in the rates of partial A PTSD rates (P = 0.048) and in the endorsement rates of criterion B (intrusion symptoms) (P = 0.047), criterion D (negative alterations in cognitions and mood) (P = 0.010) and criterion E (alterations in arousal and reactivity) (P < 0.001) too.

This is the first study to identify post-traumatic symptoms in caregivers of pediatric patients with epilepsy with the use of current diagnostic criteria and the relevance of the results suggests the need for further studies on this risk population.

The authors have not supplied their declaration of competing interest.

Rescue emergency personnel is at high risk to develop PTSD due to possible extreme and repetitive exposition to “cruel details of traumatic events”.

This study aimed to explore posttraumatic stress and subthreshold autism symptomatology and their impact on social and working functioning level among sub mariner of Italian Navy, who were employed in the Costa Concordia and Genova tower rescue operation.

Eighty-five subjects were enrolled and investigated by the following instruments: Trauma and Loss Spectrum Self-Report (TALS-SR), Adult Autism Subthreshold Spectrum (AdAS Spectrum) and Work and Social Adjustment Scale (WSAS).

The response rate was about 50%. Ninety-five percent of the subjects were employed in recovering corpses and 80% reported at least one rescue operation in the last three years. Full and partial DSM-5 PTSD rates were 8% and 27.5%, respectively. A strong correlation emerged between several TALS-SR and ADAS domain. Furthermore, TALS-SR domain scores were related to WSAS domain.

This data showed rescue personnel to be at risk for post-traumatic stress spectrum and related work and social impairment. Further studies are needed to better investigate possible risk and resilience factors associated to PTSD.

The authors have not supplied their declaration of competing interest.

In a globalized world, violence, present in all forms and everywhere, it is a serious public health problem. Violence and war lead to death and leave marks on the bodies and minds, and the post-traumatic stress disorder (PTSD) is a mental disorder that may develop following exposure to a potential event traumatic.

In the 3-month period (January 2016 to April 2016), according to typological analysis of the journal cover, the following results were found: the type of prevailing violence was interpersonal, community, committed by a stranger (75%), followed by the violence of the economic type (16.7%), and finally interpersonal violence committed by partner (8.3%). Although not all cases have provided the number of people who perpetrated or suffered violence, most victims of violence were male (8), aged 3 months and 36 years, followed by 2 women, and as a perpetrator of violence the men were in excess (4 men) followed by one woman.

Violence and war are traumatic stressors and risk factors for PTSD which, in turn, is also a risk factor to perpetrate violence, such as domestic violence. The costs of violence are high and its routinization as a way of life has important effects on the mental health of population.

Scientific research, including qualitative studies, on PTSD, violence and war are necessary so that we have a better understanding of the phenomenon as well as to promote the mental health of all through early intervention or even in preventing the onset of this disorder.

The authors have not supplied their declaration of competing interest.

Psychiatric disorders may become more severe when the subject is exposed to a hostile environment. Symptoms of mental malaise are expressed by the senses, including speech and language.

The method is used of semiotic analysis and thanatological movie.

To investigate the limit and death as a trigger of a singular mode of use of the spoken language. The problem presented in this paper is the linguistic system created by Nell.

Partial results show that spoken language in this particular cut, becomes an instrument for dealing with the losses accumulated throughout his life. The life of isolation, restrictions on maternal vocalization, her mother's death and mourning acted as an inhibitor of language.

The spoken language works like kaleidoscope of interactions of the individual with their group, with the medium in which it is inserted, with the set of beliefs that nourishes and with the world that she wants there, even if only in your intimate venue. Thus, demonstrating the sociolinguistic approach inalienable role in speech performance.

The authors have not supplied their declaration of competing interest.

Traumatic event related disorders (ASD, PTSD and dissociative disorders) could share a common dissociative psychobiological origin. Patients diagnosed with dissociative identity disorder present a high sexual abuse rate (85–90%), way above the rest of the traumatic spectrum disorders.

The goal of this study is to analyse the existing relation between different types of trauma, especially sexual abuse, and the onset and continuity of dissociative disorders.

We report the case of a 37 years old woman with a long sexual abuse history. The symptoms appear by age 30, in the form of flashbacks, ushering a persistent identity fragmentation in individual differentiated opposed components, shaping a dissociative personality disorder, which was present for years taking a fluctuating and invalidating nature.

When a traumatic event occurs, acute dissociative reactions frequently appear, usually briefly, disappearing spontaneously afterwards. In this case, we can discern the persistence of the dissociative symptoms and the repercussion they had in the patient's functionality.

The existence of a correlation between the duration of a chronic traumatic event and the persistence of dissociative symptoms in the evolution of a dissociative personality disorder is possible.

The authors have not supplied their declaration of competing interest.

Due to the professional activities acute stress disorder and PTSD are most diffuse disorders among military servants. Number of studies revealed relationships between post-traumatic stress and depression, anxiety or somatic complaints.

Though Georgian military personnel actively take part in the international peacekeeping missions since 2004 and no research was conducted to investigate the prevalence of abovementioned disorders.

Thus, this study aims to investigate the prevalence of PTSD, depression, anxiety and somatic complaints in the cohort of Georgian military servants.

The research participants were 2799 military servicemen who had been deployed on the 6 month long period to the peace-keeping missions and were screened for psychological problems after deployment. All of them were Caucasian males, with average age of 29.3 years. All participants were asked to complete a PTSD Checklist for DSM-5 (PCL-5), as well as a 15-item somatic subscale of the Patient History Questionnaire (PHQ-15), a 9-item depression subscale of the Patient History Questionnaire (PHQ-9), a 7-item anxiety subscale of the Patient History Questionnaire (GAD-7).

Prevalence rate of probable PTSD screened by the PCL-5 was 2.7%. Further investigation showed that depressive, anxiety and somatic symptoms among them was 21.6%, 8.7% and 21.7% respectively.

Appreciable positive relationship was found (r = 0.65–0.70; P < 0.001) between these variables in the deployed military servants. Therefore, it is recommended that military servants should be screened on all above mentioned conditions along with PTSD, in order to see full picture of co-morbid problems.

The authors have not supplied their declaration of competing interest.

The following study shows that PTSD, depression and anxiety present actual and urgent problem in military field. These disorders appear to be highly co-morbid that results in much more complicated treatment process and outcome. Service members of Georgian armed forces participate in various international peacekeeping operations on the regular basis, though there are no researches conducted so far to provide evidence for mental health problem prevalence in Georgian deployed military personnel.

Collection of the data took place during the period of 2014–2015 years after six months of service members returning from the international peacekeeping mission back to their homes. The sample for this research were represented by 2799 servicemen who actively engaged in ISAF peacekeeping missions. All of them were male, with average age: M = 29.3 (SD = 6.3). The data for the following research were collected using self-administered assessment measures, namely PCL-5 for PTSD screening and PHQ for depression and Anxiety and somatic complaints assessment.

PTSD appeared to be significantly predicted by range/level of anxiety and depression symptom urgency, nevertheless after joint/combine integration of these variables in one regressional equation, just symptoms of depression remained as statistically reliable explanatory factor for the significant percentage of the somatic symptom range variation.

It would be wise to recommend mental health care specialists particularly to bear in mind the possibility of co-existing depression and anxiety symptoms in patients with PTSD.

The authors have not supplied their declaration of competing interest.

While research on religious beliefs as an adjustment is on the rise, less is known regarding such process following stillbirth and no study has been conducted on a sample of Moroccan women.

The aim of the present study is to extend the current literature by:

– identifying a typology of Moroccan women who experienced stillbirth based on several dimension of religious coping strategies;

– examining whether these profile differ on grief, anxiety, posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG) symptoms.

One hundred Moroccan women who experienced stillbirth were recruited through a Moroccan public hospital. At 6 weeks following stillbirth, they completed questionnaires assessing Religious Coping Strategies (RCS), PTSD, PTG, anxious and grief symptoms.

Five clusters were identified: one with high level of plead and religious avoidance coping strategies, one with high level of interpersonal coping strategies, one with multiple religious coping strategies, one with discontent religious coping strategies and one with low religious coping strategies. High levels of psychological symptoms were found in the 5 cluster and PTG symptomatology was as associated with increased RCS.

Our findings suggest that, while religious beliefs and practices as a coping strategy do not protect from short-term psychopathological symptoms in the immediate aftermath of stillbirth, they play an important role in the development of positive reactions. As PTG symptoms have been reported be a protective factor for long term psychiatric symptomatology further longitudinal studies focusing in this area is warranted.

The authors have not supplied their declaration of competing interest.