Pseudocholinesterase (PCHE) deficiency is an inherited condition, in which recovery from anesthetic agents like succinylcholine and mivacurium is slow and complicated with prolonged paralysis of respiratory muscles in susceptible patients. Succinylcholine is used very frequently as a muscle relaxant during the procedure.

In Bakirkoy research and training hospital for psychiatric and neurological diseases, 24.310 patients were hospitalized for acute conditions and 3490 of these patients were treated with electroconvulsive therapy (ECT) in 3 years. We present a very rare case that we encountered in our practice; a severe PCHE deficiency case that could have complicated the modified ECT procedure unless necessary precautions were taken.

Detection of PCHE levels of all patients eligible for ECT is part of our pre-ECT assessments procedure, and the case presented here shows the benefits of this method.

The patient is a 29-year-old woman, with a 15 year history of schizophrenia. She was hospitalized for homicidal risk and refusal of treatment. Inadequate clinical response with pharmacological interventions and continuous aggressive excitations directed us to consider ECT.

After the detection of PCHE deficiency (PCHE level: 126 U/L), we performed the modified ECT with propophol and rocuronium instead of succinylcholine as usual. Sugammadex 100 mg was used for fastening the recovery. Response to treatment, which is recorded with positive and negative syndrome scale, was good and we completed 9 ECT sessions without complication.

Screening for PCHE levels in the pre-ECT assessments is efficacious in order to decrease the complications of the ECT procedure.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

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

Complicated Grief (CG) affects 7–10% of the grieving individuals in the general population. However, the incidence is much higher in psychiatric patients, reaching 70% in most samples. These individuals present many risk factors for such condition, demanding a particular attention and treatment approach. Most studies have shown that pharmacological treatment may help relieving depressive and anxiety symptoms, although they do not promote a consistent improvement of the grieving scenario. Several meta-analyses have recognized different psychological interventions as effective in dealing with the loss, decreasing psychological suffering and promoting adaptation. It is accepted that the benefits of the intervention overcome any possible harm.

To evaluate the impact of a group intervention (12 sessions) in pharmacologically stabilized psychiatric patients presenting with CG.

Patient selection was performed through a clinical interview and the fulfilment of the following psychometric tests: Complicated Grief Inventory; the Impact of Events Scale; Beck Depression Inventory; Social Support Scale. These assessment tools were also used to evaluate the impact of the intervention performed.

After the psychotherapeutic intervention, there were significant differences in the levels of depressive and post-traumatic stress symptoms.

Group intervention in CG has proven effective in this population, specially regarding depression and post-traumatic stress levels.

The authors have not supplied their declaration of competing interest.

Preliminary investigations of cross-sectional samples have linked trait mindfulness with measures related to the hypothalamic–pituitary–adrenal (HPA)-mediated stress response and to the inflammatory system, suggesting that this is one potential pathway linking mindfulness based interventions and health. However, no previous studies explored the association between the trait mindfulness construct and markers of cellular ageing.

In the current study we examined in a sample of healthy mothers (n = 92) of a child with Autism Spectrum Disorder (i.e. women showing high levels of chronic psychological stress) the prospective associations between a multidimensional scale of trait mindfulness, the Five Facet Mindfulness Questionnaire (FFMQ), and telomerase activity (TA), a marker of cellular ageing and telomere homeostasis. Participants’ trait mindfulness and TA were assessed at baseline as well as 9 and 18 month follow-up.

Analysis showed that higher levels of baseline mindfulness on FFMQ observation and describe subscales were related to increase in TA from baseline to 9 month (r = 0.27, P = 0.03 and r = 0.24, P = .04, respectively). Additionally, the FFMQ Describe subscale was related to increase in TA from baseline to 18 month (r = .30, P = .02). Results are reported following covariate adjustment of age, BMI, ethnicity, and education.

Our results showed that higher levels of baseline mindfulness are associated with higher increases in TA after 9 months and 18 months, with increased TA reportedly being associated with decreased oxidative damage, increased telomere length and overall more functional cellular physiology. These findings support a role of mindfulness-related interventions to increase general and mental health.

The authors have not supplied their declaration of competing interest.

Psychotherapy can ease physical symptoms of patients with skin pathology.

To study features of social and psychological maladaptation and quality of life in patients with psoriasis.

To study psychotherapy role in quality of life improvement and social rehabilitation of patients with psoriasis and their family members for the period 2000–2015 in the Belarusian population.

One hundred and twenty four patients with cutaneous psoriasis, 12 patients with psoriatic arthritis and 42 healthy persons were studied. Quality of life, types of attitude towards the disease, level of social frustration, depression, level of social maladaptation, psychological defense mechanisms and patients attitudes towards psychotherapy were assessed.

There were detected among patients with psoriasis (especially with arthropathy form): social maladaptation, higher level of social frustration and depression (P < 0.05), decrease in quality of life (P < 0.001), the wider range of psychological defense mechanisms (negation, regression, substitution, reactive formation, P < 0.05). Maladaptive types of attitude towards the disease were presented in 24% patients with psoriasis and almost in 41% patients with arthropathy.

Psychotherapy can have a high potential for social rehabilitation and quality of life improvement for patients with psoriasis. Obtained data in social maladaptation indicate family therapy as an important therapeutic part for patients with psoriasis. Moreover, knowledge about patients psychological defense mechanisms can help to choose a direction and methods of individual psychotherapy of social maladaptation. This research shows also that psychotherapeutic approach and family psychotherapy remains underestimated in Belarus.

The authors have not supplied their declaration of competing interest.

First wave cognitive behavioural therapy (CBT) focuses essentially on classical conditioning and operant learning and second wave on information processing. They are based on the premise that certain cognitions, emotions and physiological states lead to dysfunctional behaviour and so, by eliminating the first ones, changes in behaviour will take place. Third wave CBT appeared in an attempt to increase the effectiveness of first and second wave by emphasizing contextual and experiential change strategies.

To make a review on the actual state of the art of third wave CBT, focusing on MBSR (Mindfulness-Based Stress Reduction), MCBT (Mindfulness-based Cognitive Behavioural Therapy), DBT (Dialectical Behaviour Therapy), ACT (Acceptance and Commitment Therapy) and CFT (Compassion Focused Therapy).

Research on PubMed using the terms “third wave cognitive behavioural therapy”.

Methods and targets differ between MBSR, MCBT, DBT, ACT and CFT. Depression, anxiety and borderline personality disorders are some of those targets. However, a transdiagnostic approach is the hallmark of all third wave therapies: mental processes or emotions transversal to many psychiatric disorders such as shame, self-criticism, experiential avoidance or cognitive fusion are the main focus, emphasizing the context and human experience over any categorical diagnosis.

Third wave cognitive behavioural therapy is an emerging approach born from the need to improve and complement first and second waves. Although very promising, it is still a recent approach and data to support its superiority over the conventional therapies is missing.

The authors have not supplied their declaration of competing interest.

This study investigates the case of a female patient, who was experiencing marital problems and had separated from her spouse, with whom an art (drawing) therapy process was carried out.

It was aimed to address the relationship of the couple by supporting the ego and increasing self-awareness skills by means of art materials (drawings) in the process of the situational crisis.

Case study.

With this case study, it was aimed to make emphasis on the impact of drawing sessions as a means of using art in therapeutic relationships for self-awareness and opportunity for development in a situational crisis during marriage.

During the process of individual art therapy, nine sessions and eight drawing tasks were conducted. The case patient, OS, had been separated from her spouse for 2 months. In the first session, a personal history was taken, the scores of the state-trait anxiety scale was evaluated and a therapy plan was jointly developed. Each action was carried out by providing specific instructions. Each session was evaluated within the same week in a supervision meeting with an expert experienced in art therapy and the next session was planned. OS, who developed self-awareness as a result of the sessions, evaluated his/her expectations and boundaries in his/her relationship and discovered the connections with her own nuclear family. In a session with OS one year later, she gave the information that she had started to share a house with her spouse.

The authors have not supplied their declaration of competing interest.

The doctor-patient relationship has an increasingly important place in medical studies. Empathy is one of the quality criteria of the relationship. The development of mindfulness in medical schools is booming.

To investigate the relation between empathy and mindfulness among residents and doctors.

Doctors and residents were asked to complete a demographic questionnaire – questions on their personal development practices – and two scales. The Mindful Awareness Warning Scale (MAAS) is a unidimensional scale measuring attention and mindfulness and Jefferson Physician Empathy Scale (JSPE) is a scale measuring the clinical empathy across 3 dimensions: “perspective taking”, “compassionate care” and “in the patient's shoes”. Multivariate linear regressions were performed to analyse the correlation between each score of JSPE and explanatory variables.

One hundred ninety-three questionnaires were analyzed: 87% were general practitioners, the average age was 34 years old (SD 11) and 69% were women. Regarding personal development practices, 18% practised mindfulness meditation regularly or occasionally (23% for yoga and 31% for relaxation). No correlation between the scores of JSPE and the MAAS score was found. However, doctors who practiced mindfulness had a highest score of “compassionate care” (95% CI [1.26; 4.91], P = 0.0012).

The mindfulness would be an effective tool for the development of the welfare of the doctors, and improving the quality of empathy and therapeutic efficacy. To support these data, it would be interesting to conduct an interventional study by offering French doctors and interns the possibility of following courses of mindfulness.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The In-patient units are very closed and highly controlled healthcare resource and then patients have to join the community rapidly, and in sometimes feeling unprotected and with their needs non covered. We created a transition unit with a program of psychotherapeutic intervention, to offer an adequate transition between the acute episode and the incorporation to the community.

We describe the characteristics of the psychotherapeutic group, the aims and the results of the interventions.

Psychotherapeutic transition unit was created to offer intensive attention and control demand that is not possible to control in the community. The objects are to prevent re-admissions and relapse because of abandonment of treatment in patient with personality disorder and suicide attempts, and first episode, affective or psychotic. Patients are selected from the in-patients unit with inclusion criteria, and start going from the unit before discharge. The intervention is once per week, with a duration between 60–90 minutes. There is not a number of sessions, and we have approximately 10 patients per sessions.

Since the beginning of the psychotherapeutic interventions, re-admissions have been decreased in patients with diagnosis of personality disorder (most histrionic and borderline disorder) with multiple admissions because of suicide attempt, some had been discharged. In another group of patient we have prevented relapses.

Psychotherapeutic interventions will be effective in patients with high risk of re-admissions and relapses. It is early to have solid conclusions, but the preliminary results encourage the continuation of the program.

The authors have not supplied their declaration of competing interest.

Counseling addresses the emotional social, work, school and physical health concerns that people may have at different stages in their lives. It focuses on typical life stresses and more severe issues. It may be addressed to individuals, groups, organisations.

The objective of our study was to assess the outcome of a counseling intervention offered to students of the University of Piemonte Orientale, aged between 18 and 20 years. Baseline features and reasons for consultation will be described and the outcome will be assessed with CGI (Clinical Global Impression) and HONOS (Health of the Nation Outcome Scales) at T0 (time 0), T1 (4 weeks) and T2 (8 months). We will present the data of the period between 1st January 2014 to 31st December 2016.

Data analysis is ongoing. The results will be discussed in the light of the current literature about counseling services for university student.

The authors have not supplied their declaration of competing interest.

The present study aims to evaluate the effectiveness of cognitive behavioral therapy (CBT) and spiritual-religious intervention in improvement coping responses and quality of life among women surviving from breast cancer.

This was a semi-experimental study. Forty-five breast cancer survivor referred to cancer research center at Shahid Beheshti university of medical Sciences in Tehran, assigned in 3 groups randomly (CBT group, spiritual-religious group and control group). The interventions were eight sessions cognitive-behavioral therapy and spiritual-religious intervention. The participants were evaluated through quality of life questionnaire published by european organization for research and treatment of cancer (QLQ-30C-ver3) and coping responses inventory (CRI). The data were analyzed using covariance.

Although both intervention groups improved in coping and quality of life, it was not statistically significant(P < 0.08).

Although both intervention groups improved in coping and quality of life but there is no differences between two groups.

The authors have not supplied their declaration of competing interest.

Suicidal adolescents have a severely damaged body/mind relationship where issues pertaining to adolescence and psychache are tightly intertwined causing dissociation, hallucinations and concreteness. In this conundrum, the suffering mind swings from being identified and split from the body favouring self-harm and bodily together with visual hallucinations.

Investigating and working through suicidal concreteness together with the role and meaning of hallucinations in adolescents with a story of multiple suicide attempts.

Achieving a first integration and appropriation of the emotional experience with the establishment of the boundaries between mind/body, inside/outside giving up hallucinations.

Prolonged intensive psychodynamic work focusing on self-representation, the working through of persecutory internal objects causing rage, hostility and attacks on the affective links with the environment allowed a gradual process of integration of the self with the decrease of suicidiality.

The working through and containment of persecutory internal objects led to the possibility to unconsciously give up hallucinations and integrate the emotional experience in the mind together with the development of first effective boundaries between inside/outside.

An intense work of containment and working through of persecution and rage in the early stages of the psychotherapeutic treatment of adolescent multiple attempters can significantly favour the relinquishment of hallucinatory mechanisms and self-harm as a way to cope with intolerable anguish and psychache. This favours the process of in dwelling of the psyche in the soma as described by Winnicott.

The authors have not supplied their declaration of competing interest.

Cognitive-Analytic Therapy (CAT) has settled as an integrative approach from Ryle and Kerr's model in the 70's widely accepted in England and Australia, although increasingly European countries have decided to include this model in their public mental health services. Even though its formulation allows the treatment of almost any pathology ensuring good results, it has been traditionally applied to the treatment of personality and eating disorders. Some authors seem to link this efficacy with training in mental states and reciprocal role procedures identification, justifying the improvement through the increase of the reflexive function.

The aim of this study is to determine the effect of CAT in mentalizing ability and social functioning in patients attending consultation.

For this purpose a CAT intervention was performed in 6 adults, administering the Inventory of Interpersonal Problems (IIP-64) and the Mindful Awareness Assessment Scale (MAAS) before and after treatment.

The results show a statistically significant reduction in interpersonal problems, as well as a non-significant increase in the mentalizing ability.

Cognitive Analytic Therapy has shown being effective in increasing social functioning, however we have not been able to demonstrate significantly its efficacy in the reflexive function.

Implications in the clinical setting are discussed.

The authors have not supplied their declaration of competing interest.

Our two units take care of a rather big number of people (about 170 000). Various activities are proposed for outpatients and the idea was expressed to initiate art therapy.

We first analysed the possibility of starting this new mediation equally in the two units. A team was formed: a clinical psychiatrist and two registered nurses, one being an art therapist as well. We started this activity with a small group of out patients in April 2016.

The registered nurse – art therapist was provided with appropriate space, art material and furniture by hospital sources. The other unit will send the nurse for training in art – therapy: leave and grant are provided by the hospital. Her project is different and yet complementary.

The group was validated and evaluated by the art therapist and the psychiatrist. The organization of the activity is left to the art therapist. A questionnaire was filled out by art therapist before beginning the art therapy and at regular intervals.

Patients are engaged by this therapy and come on regular basis. They chose painting to express themselves and leave their productions in the room after they are finished.

The newly opened psychotherapy – art therapy has brought many positive changes in our hospital for working staff as well as for the patients.

The authors have not supplied their declaration of competing interest.

We want to thank the Chiefs of our Department of Psychiatry, Grandin Pascal, MD and Benzaken-Charlier Catherine MD for their acceptance and support of this project.

Psychodynamic concepts describe object relations deficits in patients with schizophrenia originating from their earliest developmental stage, which is due to reduced ability of direct caregivers to adequately stimulate the child, as well as genetic factors. During psychodynamic group psychotherapy, members through psychotherapy gradually release the old family roles and experiment with new models of behaviour and thus change internalized object representations.

The aim of this study was to investigate changes in object relationships and self-esteem in the psychodynamic group psychotherapy in young patients suffering from schizophrenia.

The study included a total of 41 patients diagnosed with schizophrenia. Before joining the psychodynamic group therapy and after two years of participation in the treatment, all patients completed a test of object relations and the Rosenberg self-esteem scale.

Comparison of the results in two time periods showed downward trend results in all tested dimensions of object relations, a statistically significant difference was found for dimension symbiotic fusion: after two years of participation in the psychodynamic group psychotherapy, patients had significantly expressed less need for symbiotic relationships. Self-esteem was higher in the second period of testing, but without statistical significance.

Taking into account the limitations of this study, we can conclude that the results are encouraging. During psychodynamic group processes in young patients with schizophrenia there is a trend of positive changes in terms of object relations and self-esteem and a significant reduction in the need for symbiotic merging.

The authors have not supplied their declaration of competing interest.

Data on the comparative effect of short and long-term psychotherapy in anxiety disorder is scarce.

To compare the effectiveness of two short-term therapies and one long-term psychotherapy in the treatment of patients with anxiety disorder.

Altogether 50 outpatients with anxiety disorder as the only axis I diagnosis, were randomly assigned to long-term psychodynamic psychotherapy (LPP), short-term psychodynamic psychotherapy (SPP), and solution-focused therapy (SFT) and were followed for 5 years. The outcome measures were psychiatric symptoms, working ability, need for psychiatric treatment, remission, and cost-effectiveness.

During the first year of follow-up, no significant differences in the effectiveness between the therapies were noted. During the following 3 years, LPP and SFT more effectively reduced symptoms, improved work ability, and elevated the remission rate than SPP. No significant differences between LPP and SFT were seen. At the end of the follow-up, the use of auxiliary treatment was lowest in the SFT group whereas remission rates or changes in psychiatric symptom or work ability did not differ between the groups. The average total direct costs were about three times higher in the LPP group than in the short-term therapy groups.

The difference in effectiveness of LPP and SFT was negligible, whereas SPP appeared less effective. Thus, the resource-oriented SFT may be a cost-effective option in this selected patient group, while unconsidered allocation of patients to LPP does not appear to be cost-effective. Given the small number of patients, no firm conclusions should, however be drawn based on this study.

The authors have not supplied their declaration of competing interest.

According to studies done in recent years regarding the treatment of patients with melancholy in major depressive disorder, a shift of interest from studies evaluating the effectiveness of therapy to the study of remission is seen. Despite significant progress in the development of pharmacotherapy of depressive disorders, difficulty in achieving rapid reduction in depressive symptoms and stable remission in patients with melancholic depression necessitated the search for new approaches to the treatment of this pathology.

Evaluating the effectiveness of art therapy in treatment in patients with melancholy in major depressive disorder on the quality of remission.

The study involved 135 patients – 60 male and 75 female patients aged from 18 to 30 years old. The main group of patients apart the combined treatment also participated in group art therapy with the use of drawing techniques, while the control group – statutory standard therapy.

The results of the use of art therapy in complex treatment in patients with major depressive disorder is detected primarily in reducing of the level of anxiety at the early stages of treatment (60% of patients have noticed decreasing of melancholic state), as well as improving the quality of life in remission period.

These results support the use of art therapy in treatment in patients with melancholy in major depressive disorder during period of active treatment, and after achieving clinical remission contributes to achieving and maintaining high-quality and stable remission with full restoration of quality of life and social functioning.

The authors have not supplied their declaration of competing interest.

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